Provider Demographics
NPI:1902931959
Name:RONALD HOLNESS, M.D.,INC
Entity Type:Organization
Organization Name:RONALD HOLNESS, M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-598-2439
Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:STE. 420
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-598-2439
Mailing Address - Fax:562-598-0022
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:STE. 420
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-598-2439
Practice Address - Fax:562-598-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G556051Medicaid
CA00G556051Medicaid