Provider Demographics
NPI:1154690774
Name:RONALD A KALAYTA MEDICAL CORPORATION
Entity type:Organization
Organization Name:RONALD A KALAYTA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALAYTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-674-8170
Mailing Address - Street 1:901 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3323
Mailing Address - Country:US
Mailing Address - Phone:530-674-8170
Mailing Address - Fax:530-674-5728
Practice Address - Street 1:901 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3323
Practice Address - Country:US
Practice Address - Phone:530-674-8170
Practice Address - Fax:530-674-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG228240207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G228240OtherMEDICARE ID-TYPE UNSPECIFIED
CA00G228240Medicaid
A41736Medicare UPIN
CA00G228240OtherMEDICARE ID-TYPE UNSPECIFIED