Provider Demographics
NPI:1811986599
Name:LIEBERMAN, RONALD E (DPM)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 DEVONSHIRE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5136
Mailing Address - Country:US
Mailing Address - Phone:760-942-1890
Mailing Address - Fax:
Practice Address - Street 1:1011 DEVONSHIRE DR
Practice Address - Street 2:SUITE F
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5136
Practice Address - Country:US
Practice Address - Phone:760-942-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3332213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACU297ZMedicare PIN
CAT11638Medicare UPIN