Doctor Name: | ELAINE THERESE VAN GUNDY |
NPI Number: | 1174565485 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D., F.A.A.P. |
License Number: | C43153 |
Business Practice Address: | 1451 Secret Ravine Pkwy Suite 150 Roseville, CA - 956614051 |
Business Phone Number: | 9165802420 |
Business Fax Number: | 9165802402 |
Mailing Address: | 1451 Secret Ravine Pkwy, Suite 150 ROSEVILLE |
State: | CA |
Postal Code: | 956614051 |
Phone Number: | 9165802420 |
Fax Number: | 9165802402 |
NPI Enumeration Date: | 06/12/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | C43153 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |