Provider Demographics
NPI:1487765343
Name:KRUMHOLZ, HENRY RONALD (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:RONALD
Last Name:KRUMHOLZ
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 1:272 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2718
Mailing Address - Country:US
Mailing Address - Phone:619-427-1721
Mailing Address - Fax:
Practice Address - Street 1:272 CHURCH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2718
Practice Address - Country:US
Practice Address - Phone:619-427-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34785207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G347850Medicaid
A46081Medicare UPIN
G34785Medicare ID - Type Unspecified