Provider Demographics
NPI:1932166865
Name:PELTZ, RONALD HOWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HOWARD
Last Name:PELTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1303 AVOCADO AVE
Mailing Address - Street 2:SUITE #195
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7802
Mailing Address - Country:US
Mailing Address - Phone:949-718-9878
Mailing Address - Fax:949-718-9848
Practice Address - Street 1:1303 AVOCADO AVE
Practice Address - Street 2:SUITE #195
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7802
Practice Address - Country:US
Practice Address - Phone:949-718-9878
Practice Address - Fax:949-718-9848
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1451213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10962Medicare UPIN
CA5508570001Medicare NSC