Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | G44009 | CA |
NPI | 1023109048 |
---|---|
Provider Name | Lawrence E Vondollen |
First Address | San Luis Obispo, CA 93401-4154 |
Second Address | Templeton, CA 93465-4055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060044244 | RAILROAD MEDICARE (01) | CA |
A49521 | (02) | CA |
GR0068680 | (05) | CA |
ZZZ28458Z | BLUE SHIELD (01) | CA |