Provider Demographics
NPI:1023142015
Name:ISRAEL, RONALD M (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:ISRAEL
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 1:3 KITE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1418
Mailing Address - Country:US
Mailing Address - Phone:831-429-1429
Mailing Address - Fax:831-429-5580
Practice Address - Street 1:3 KITE HILL RD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1418
Practice Address - Country:US
Practice Address - Phone:831-429-1429
Practice Address - Fax:831-429-5580
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE25946207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology