Basic Information
| Provider Information | |||||||||
| NPI: | 1003018391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMMONS | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD, MSW, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2303 25TH AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946011211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102196405 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2303 25TH AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946011211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102196405 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 12/06/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.