Provider Demographics
NPI:1477812212
Name:BRIZUELA-GARCIA, RONALD ALEXANDER (IDC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALEXANDER
Last Name:BRIZUELA-GARCIA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 VIA SOVANA
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3488
Mailing Address - Country:US
Mailing Address - Phone:619-534-7186
Mailing Address - Fax:
Practice Address - Street 1:29 VIA SOVANA
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3488
Practice Address - Country:US
Practice Address - Phone:619-534-7186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman