Provider Demographics
NPI:1518778174
Name:GARDNER, RONALD JAMES
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:GARDNER
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 1:9433 ALDER ST
Mailing Address - Street 2:9433 ALDER STREET
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9173
Mailing Address - Country:US
Mailing Address - Phone:909-322-0588
Mailing Address - Fax:
Practice Address - Street 1:9433 ALDER ST
Practice Address - Street 2:9433 ALDER STREET
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9173
Practice Address - Country:US
Practice Address - Phone:909-322-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical