Healthcare Provider Details

I. General information

NPI: 1407422199
Provider Name (Legal Business Name): JORGE LUIS VENDRELL SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NORTHWESTERN DR STE 1
STORM LAKE IA
50588-2935
US

IV. Provider business mailing address

620 NORTHWESTERN DR STE 1
STORM LAKE IA
50588-2935
US

V. Phone/Fax

Practice location:
  • Phone: 712-732-5030
  • Fax:
Mailing address:
  • Phone: 712-732-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number22556
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number22556
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56760
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: