| Ronald Shigematsu | |
|
1245 Wilshire Blvd Ste 680 Los Angeles CA 90017-4880 | |
| (213) 628-1020 | |
| Not Available |
| Full Name | Ronald Shigematsu |
|---|---|
| Speciality | Family Medicine |
| Location | 1245 Wilshire Blvd Ste 680, Los Angeles, California |
| Authorized Official Name and Position | Ronald Shigematsu (OWNER) |
| Authorized Official Contact | 2136281020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ronald Shigematsu 1245 Wilshire Blvd Ste 680 Los Angeles CA 90017-4880 Ph: (213) 628-1020 | Ronald Shigematsu 1245 Wilshire Blvd Ste 680 Los Angeles CA 90017-4880 Ph: (213) 628-1020 |
| NPI Number | 1114190907 |
|---|---|
| Provider Enumeration Date | 04/11/2008 |
| Last Update Date | 08/22/2024 |
| Medicare PECOS PAC ID | 2264557354 |
|---|---|
| Medicare Enrollment ID | O20100913000924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114190907 | NPI | - | NPPES |
| GR0045240 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G51244 (California) | Primary |
| Provider Name | Ronald Shigematsu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194899831 PECOS PAC ID: 5597958348 Enrollment ID: I20101025000942 |
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