Basic Information
| Provider Information | |||||||||
| NPI: | 1437336104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANNER | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | HARLAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1041 REDONDO AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908043928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627155801 | ||||||||
| FaxNumber: | 5629874586 | ||||||||
| Practice Location | |||||||||
| Address1: | 1041 REDONDO AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908043928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627155801 | ||||||||
| FaxNumber: | 5629874586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2008 | ||||||||
| LastUpdateDate: | 01/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY3399 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.