MEDICARE: JAMES J VONHOLLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1225182033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES J VONHOLLE

Provider Business Mailing Address
First Line	:	11835 CARMEL MOUNTAIN RD
Second Line	:	#1302
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4609
Country	:	US
Telephone Number	:	858-674-6263
Fax Number	:	858-674-6249

Provider Business Practice Location Address
First Line	:	11835 CARMEL MOUNTAIN RD
Second Line	:	#1302
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4609
Country	:	US
Telephone Number	:	858-674-6263
Fax Number	:	858-674-6249

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES J VONHOLLE
Credential	:
Telephone Number	:	858-674-6263

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	06/19/2009

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