Healthcare Provider Details

I. General information

NPI: 1730795881
Provider Name (Legal Business Name): VALERIE RONDONE RADIOGRAPHER (R)(CT)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2574 RALEIGH WAY
EL DORADO HILLS CA
95762-6973
US

IV. Provider business mailing address

2574 RALEIGH WAY
EL DORADO HILLS CA
95762-6973
US

V. Phone/Fax

Practice location:
  • Phone: 916-715-7374
  • Fax:
Mailing address:
  • Phone: 916-715-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number00087877
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number00087877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: