=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225182033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES J VONHOLLE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 06/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11835 CARMEL MOUNTAIN RD #1302
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-4609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-674-6263
-----------------------------------------------------
Fax | 858-674-6249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11835 CARMEL MOUNTAIN RD #1302
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-4609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-674-6263
-----------------------------------------------------
Fax | 858-674-6249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JAMES J VONHOLLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-674-6263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------