Provider Demographics
NPI:1639115603
Name:CARLISH, RONALD ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:ARTHUR
Last Name:CARLISH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 GLENHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2201
Mailing Address - Country:US
Mailing Address - Phone:310-454-2133
Mailing Address - Fax:
Practice Address - Street 1:906 GLENHAVEN DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2201
Practice Address - Country:US
Practice Address - Phone:310-454-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39524Medicare UPIN