Provider Demographics
NPI:1932548393
Name:NEGRON, RICARDO JOSE
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:JOSE
Last Name:NEGRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21661 BROOKHURST ST APT 285
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-8135
Mailing Address - Country:US
Mailing Address - Phone:714-600-2404
Mailing Address - Fax:
Practice Address - Street 1:1038 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2111
Practice Address - Country:US
Practice Address - Phone:714-771-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5260213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery