Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | CFE25946 | CA |
NPI | 1023142015 |
---|---|
Provider Name | Ronald M. Israel |
First Address | Santa Cruz, CA 95060-1418 |
Second Address | Santa Cruz, CA 95060-1418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |