# RONALD GLOUSMAN MD MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922421171
- **Authorized official:** RONALD ERIC GLOUSMAN MD (PRESIDENT)
- **Authorized official phone:** (714) 313-1454

## Contact information

- **Practice address:** 999 N TUSTIN AVE, STE 114, SANTA ANA, CA 92705-3528
- **Practice address phone:** (714) 508-1981
- **Practice address fax:** (866) 807-7466
- **Mailing address:** PO BOX 570627, TARZANA, CA 91357-0627
- **Mailing address phone:** (310) 659-9116
- **Mailing address fax:** (866) 807-7466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 01/23/2014
- **Last updated:** 08/20/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1104897289 | INDIVIDUAL NPI | CA |