Doctor Name: | MR. DALE A VONRUDEN |
NPI Number: | 1750526596 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | CFE31040 |
Business Practice Address: | 921 Longview Ave Pismo Beach, CA - 934492430 |
Business Phone Number: | 8057731708 |
Business Fax Number: | |
Mailing Address: | 921 Longview Ave, PISMO BEACH |
State: | CA |
Postal Code: | 934492430 |
Phone Number: | 8057731708 |
Fax Number: | |
NPI Enumeration Date: | 12/09/2008 |
NPI Last Update Date: | 12/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | CFE31040 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |