Ronald P Marmolejo, DPM
Individual provider
Active NPI
Podiatrist · Porterville, CA
NPI 1104834183 · NPPES record last updated Jul 20, 2015
Key facts
- NPI
- 1104834183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- E2925 (CA)
- Practice address
- 515 W Morton Ave
Porterville, CA 93257
- Phone
- (559) 781-0364
- Fax
- (559) 781-3625
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20051109000323 |
CA |
Practitioner - Podiatry |
0042238990 |
Practice locations: Porterville, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| E2925 | CA | MD | Podiatrist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Podiatrist |
213E00000X |
E2925 |
CA |
Yes |
Addresses
Primary practice location
515 W Morton Ave
Porterville, CA 93257
Mailing address
515W Morton Ave
Porterville, CA 93257-3303
Phone (559) 781-0364
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 000E29250 | Medicaid | CA | |