Provider Demographics
NPI:1205133279
Name:PARSA, RONNA SIMIN (DO)
Entity type:Individual
Prefix:DR
First Name:RONNA
Middle Name:SIMIN
Last Name:PARSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N PROSPECT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3030
Mailing Address - Country:US
Mailing Address - Phone:310-372-4646
Mailing Address - Fax:310-798-4667
Practice Address - Street 1:510 N PROSPECT AVE STE 105
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3030
Practice Address - Country:US
Practice Address - Phone:310-372-4646
Practice Address - Fax:310-798-4667
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13769207X00000X
CA20A15524207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL187776Medicaid
FL4809305OtherCIGNA
AL593-20159OtherBCBS OF ALABAMA
FLK75WVOtherFLORIDA BLUE
P01696203OtherMEDICARE RAILROAD
FL4809305OtherCIGNA