Individual provider Active NPI

Ronald Castillo Tejada Jr., MD

  • Internal Medicine Physician
  • Carson, CA
National Provider Identifier
1407165079
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A118334 Issued in CA
Practice address
20920 Chico St
Carson, CA 90746-3603
Phone
(424) 444-5097
Fax
(833) 973-3630
NPI assigned
Sep 30, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A118334 CA Primary
Internal Medicine Physician 207R00000X 036130801 IL

Addresses

Primary practice location

20920 Chico St
Carson, CA 90746-3603

Mailing address

3300 E South St
Suite 205
Lakewood, CA 90805-4549
Phone (562) 531-0377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121204000426 CA Practitioner - Internal Medicine 1557513207 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036130801ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthcare Partners Affiliates Medical Group CurrentSince Jan 1, 2015 Accepting new patients
Healthcare Partners Affiliates Medical Group Internal Medicine CurrentSince Jan 1, 2015 Accepting new patients
Jesse J Licuanan MD a Medical Corporation Internal Medicine Past Accepting new patients
Memorial Medical Group Inc Past Accepting new patients

Locations

1236 N Magnolia Ave
Anaheim, CA 92801
Phone (714) 995-1000

5957 W Ramsey St
Banning, CA 92220
Phone (951) 845-8864

2910 Jefferson St
Ste 100
Carlsbad, CA 92008
Phone (760) 729-8600

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

9920 Talbert Ave
Fountain Vly, CA 92708
Phone (714) 236-4000

9930 Talbert Ave
Fountain Vly, CA 92708
Phone (714) 964-6229

1025 W Olympic Blvd
Los Angeles, CA 90015
Phone (213) 623-2225

3501 S Harbor Blvd
Santa Ana, CA 92704
Phone (714) 784-1658

1700 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 883-8611

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1407165079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST",
            "address_2": "SUITE 205",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "908054549",
            "telephone_number": "562-531-0377",
            "fax_number": "562-531-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20920 CHICO ST",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463603",
            "telephone_number": "424-444-5097",
            "fax_number": "833-973-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEJADA",
        "first_name": "RONALD",
        "middle_name": "CASTILLO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-30",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A118334",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036130801",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carson, CA

Sources for this page

Verify at the official NPI Registry.