Basic Information
| Provider Information | |||||||||
| NPI: | 1619272374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UGGLA | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 S K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932745416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596882043 | ||||||||
| FaxNumber: | 5596881304 | ||||||||
| Practice Location | |||||||||
| Address1: | 327 S K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932745416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596882043 | ||||||||
| FaxNumber: | 5596881304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2011 | ||||||||
| LastUpdateDate: | 11/09/2017 | ||||||||
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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 | 106H00000X | 103015 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.