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General NPI Number Information
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NPI Number | 1104145861
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Entity Type | Organization
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Legal Business Name | DON MICHAEL ENDRESS MD
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 3191 EL PRADO RD SUITE D
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City | LA GRANGE
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State | CA
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Zip | 95329-9761
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Country | US
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Telephone | 209-852-2764
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Fax | 209-852-2766
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Provider Business Mailing Address
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Address Line | 2416 CANASTA CT
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City | LA GRANGE
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State | CA
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Zip | 95329-9633
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Country | US
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Telephone | 209-852-2765
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Fax | 209-852-2766
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SANDRA MARIE DE LA TORRE
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Credential |
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Telephone | 209-874-2345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A53357
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License Number State | CT
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