Provider Demographics
NPI:1730503194
Name:BOSE, RONN (DPT)
Entity type:Individual
Prefix:DR
First Name:RONN
Middle Name:
Last Name:BOSE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45281 AMBERLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-9166
Mailing Address - Country:US
Mailing Address - Phone:951-303-9007
Mailing Address - Fax:201-523-8573
Practice Address - Street 1:45281 AMBERLEAF WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-9166
Practice Address - Country:US
Practice Address - Phone:951-303-9007
Practice Address - Fax:201-523-8573
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12076172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist