Provider Demographics
NPI:1780782979
Name:ALONZO, RONALIE BERNARDO (MD)
Entity type:Individual
Prefix:
First Name:RONALIE
Middle Name:BERNARDO
Last Name:ALONZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N TUSTIN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3850
Mailing Address - Country:US
Mailing Address - Phone:714-619-5391
Mailing Address - Fax:770-701-6655
Practice Address - Street 1:3833 WORSHAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1766
Practice Address - Country:US
Practice Address - Phone:562-426-2606
Practice Address - Fax:562-426-5866
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G764000Medicaid
CA00G764001Medicare PIN
CA00G764000Medicaid
CACB237482 (PAMA-LA)Medicare PIN
CAP01680979 (PAMA R/R)Medicare PIN
CACB202965 (OC)Medicare PIN
CACB237483 (PAMA-OC)Medicare PIN
G02991Medicare UPIN