Provider Demographics
NPI:1588716336
Name:ELESH, RONALD L (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:ELESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1001
Mailing Address - Country:US
Mailing Address - Phone:619-532-5761
Mailing Address - Fax:619-532-8353
Practice Address - Street 1:34800 BOB WILSON DR STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1001
Practice Address - Country:US
Practice Address - Phone:619-532-5761
Practice Address - Fax:619-532-8353
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0250372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1424102Medicaid