Provider Demographics
NPI:1972124865
Name:SIREGAR, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SIREGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 E CARSON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2262
Mailing Address - Country:US
Mailing Address - Phone:310-233-3203
Mailing Address - Fax:310-549-7010
Practice Address - Street 1:824 E CARSON ST STE 101
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2262
Practice Address - Country:US
Practice Address - Phone:310-233-3203
Practice Address - Fax:310-549-7010
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA190650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine