Provider Demographics
NPI:1215119250
Name:PRATT, RONALD JAMES (PA-C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAMES
Last Name:PRATT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 E AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-4075
Mailing Address - Country:US
Mailing Address - Phone:909-580-0735
Mailing Address - Fax:
Practice Address - Street 1:1910 S ARCHIBALD AVE STE E2
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8503
Practice Address - Country:US
Practice Address - Phone:909-930-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant