Provider Demographics
NPI:1255413332
Name:HIMELMAN, RONALD B (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:HIMELMAN
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 1:555 TACHEVAH BUILDING 1 WEST
Mailing Address - Street 2:STE 202
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-323-2174
Mailing Address - Fax:760-864-9826
Practice Address - Street 1:555 TACHEVAH BUILDING 1 WEST
Practice Address - Street 2:STE 202
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-323-2174
Practice Address - Fax:760-322-6244
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54463207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G544630Medicaid
CA00G544630Medicaid
E56198Medicare UPIN