Basic Information
| Provider Information | |||||||||
| NPI: | 1598914574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKLASH | ||||||||
| FirstName: | RON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902665219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546821858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2898 LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908061627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625958671 | ||||||||
| FaxNumber: | 5624902015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2008 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0000X | A123693 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | ZZZ73964Z | 01 | CA | MEDI-CAL | OTHER |