Healthcare Provider Details

I. General information

NPI: 1326106501
Provider Name (Legal Business Name): DON MICHAEL ENDRESS M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 WELCH ST
WATERFORD CA
95386-8765
US

IV. Provider business mailing address

2416 CANASTA CT
LA GRANGE CA
95329-9633
US

V. Phone/Fax

Practice location:
  • Phone: 209-874-2345
  • Fax: 209-874-3926
Mailing address:
  • Phone: 209-874-2345
  • Fax: 209-874-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA53357
License Number StateCA

VIII. Authorized Official

Name: DON MICHAEL ENDRESS
Title or Position: MD
Credential: M.D.
Phone: 209-874-2345