Provider Demographics
NPI:1992203434
Name:DETOMASO, RONALD PATRICK
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:PATRICK
Last Name:DETOMASO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1410
Mailing Address - Country:US
Mailing Address - Phone:651-789-3100
Mailing Address - Fax:651-789-0805
Practice Address - Street 1:492 WINONA ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2470
Practice Address - Country:US
Practice Address - Phone:652-955-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
BC637087OtherMN STATE BUILDING/CONTRACTOR LICENSE