Provider Demographics
NPI:1811091978
Name:OFFENSTEIN, RONALD EARL (PHD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:EARL
Last Name:OFFENSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5887 BROCKTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506
Mailing Address - Country:US
Mailing Address - Phone:951-275-8500
Mailing Address - Fax:951-275-8560
Practice Address - Street 1:5887 BROCKTON AVE
Practice Address - Street 2:SUITE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-275-8500
Practice Address - Fax:951-275-8560
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6287103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R27502Medicare UPIN
CA00PL62870Medicare ID - Type Unspecified