Provider Demographics
NPI:1992053441
Name:POLITO, RONALD LEONARD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LEONARD
Last Name:POLITO
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:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91012
Mailing Address - Country:US
Mailing Address - Phone:818-421-4446
Mailing Address - Fax:818-790-0118
Practice Address - Street 1:4381 SHEPHERDS LANE
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011
Practice Address - Country:US
Practice Address - Phone:818-421-4446
Practice Address - Fax:818-790-0118
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE22005207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22866Medicare UPIN