Provider Demographics
NPI:1992875983
Name:RONALD V. BJARNASON DO INC
Entity type:Organization
Organization Name:RONALD V. BJARNASON DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:BJARNASON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-669-2655
Mailing Address - Street 1:PO BOX 1179
Mailing Address - Street 2:
Mailing Address - City:HILMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95324-1179
Mailing Address - Country:US
Mailing Address - Phone:209-669-2655
Mailing Address - Fax:209-669-2657
Practice Address - Street 1:8397 N. LANDER AVE
Practice Address - Street 2:
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-1179
Practice Address - Country:US
Practice Address - Phone:209-669-2655
Practice Address - Fax:209-669-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5161208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX51611Medicaid
CA02OA51610Medicare ID - Type Unspecified
CA00AX51611Medicaid