Individual
DR. RONALD DEMETRI LISKANICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
954 W FOOTHILL BLVD STE B, UPLAND, CA 91786
(909) 949-7500
(909) 946-1133
Mailing address
954 W FOOTHILL BLVD STE B, UPLAND, CA 91786-3782
(909) 949-7500
(909) 946-1133
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
20A4952
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX49520
—
CA
01
—
020A49520
BLUE SHIELD
CA
Enumeration date
12/13/2006
Last updated
10/18/2018
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