Provider Demographics
NPI:1366747883
Name:BRONOW, RONALD STANLEY
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STANLEY
Last Name:BRONOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 CROWNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4815
Mailing Address - Country:US
Mailing Address - Phone:818-906-7906
Mailing Address - Fax:818-906-7908
Practice Address - Street 1:3571 CROWNRIDGE DR
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4815
Practice Address - Country:US
Practice Address - Phone:818-906-7906
Practice Address - Fax:818-906-7908
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO19095207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology