Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G34928 | CA |
NPI | 1790849685 |
---|---|
Provider Name | Dr. Fred John Vonstieff |
First Address | Concord, CA 94520-2019 |
Second Address | Concord, CA 94520-2019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 30/07/2014 |