Provider Demographics
NPI:1265854665
Name:RONAN, ANGELA JOY (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JOY
Last Name:RONAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BREAKWATER RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3217
Mailing Address - Country:US
Mailing Address - Phone:760-310-2424
Mailing Address - Fax:
Practice Address - Street 1:1881 BUSINESS CENTER DR
Practice Address - Street 2:11 AND 12
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3465
Practice Address - Country:US
Practice Address - Phone:909-884-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17942103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical