Healthcare Provider Details

I. General information

NPI: 1225291727
Provider Name (Legal Business Name): JONATHAN VELLINGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 YNEZ RD STE 100
TEMECULA CA
92591-4649
US

IV. Provider business mailing address

27450 YNEZ RD STE 100
TEMECULA CA
92591-4649
US

V. Phone/Fax

Practice location:
  • Phone: 951-383-4333
  • Fax: 951-506-2361
Mailing address:
  • Phone: 951-383-4333
  • Fax: 951-506-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC154177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: