Provider Demographics
NPI:1780356295
Name:MOLDOVAN, RONELA KIMBERLY (OD)
Entity type:Individual
Prefix:
First Name:RONELA
Middle Name:KIMBERLY
Last Name:MOLDOVAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RONELA
Other - Middle Name:KIMBERLY
Other - Last Name:TAVOC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:26355 SNOWDEN AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374
Mailing Address - Country:US
Mailing Address - Phone:909-435-8267
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST.
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-558-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist