Provider Demographics
NPI:1194779710
Name:DE LA PENA, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:DE LA PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 LYNN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1901
Mailing Address - Country:US
Mailing Address - Phone:805-495-1066
Mailing Address - Fax:805-497-1428
Practice Address - Street 1:2230 LYNN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1901
Practice Address - Country:US
Practice Address - Phone:805-495-1066
Practice Address - Fax:805-497-1428
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54034207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A540340Medicaid
CA00A540340Medicaid
CAWA54034DMedicare ID - Type Unspecified