Healthcare Provider Details

I. General information

NPI: 1780678706
Provider Name (Legal Business Name): SACHO RADE KONDOVSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28780 SINGLE OAK DR SUITE 160
TEMECULA CA
92590-3625
US

IV. Provider business mailing address

1095 MARSHALL WAY STE 100,201,202,203
PLACERVILLE CA
95667-5722
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-4193
  • Fax: 951-719-1469
Mailing address:
  • Phone: 530-626-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: