Healthcare Provider Details

I. General information

NPI: 1144207333
Provider Name (Legal Business Name): DONALD E REDIKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 250
MISSION VIEJO CA
92691-8038
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 250
MISSION VIEJO CA
92691-8038
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-3570
  • Fax: 949-364-3430
Mailing address:
  • Phone: 949-364-3570
  • Fax: 949-364-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG48167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: