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12700 Welch St Waterford CA 95386-8765 | |
(209) 874-2345 | |
(209) 874-3926 |
Full Name | |
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Speciality | General Practice |
Location | 12700 Welch St, Waterford, California |
Authorized Official Name and Position | Don Michael Endress (MD) |
Authorized Official Contact | 2098742345 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2416 Canasta Ct La Grange CA 95329-9633 Ph: (209) 874-2345 | 12700 Welch St Waterford CA 95386-8765 Ph: (209) 874-2345 |
NPI Number | 1326106501 |
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Provider Enumeration Date | 12/04/2006 |
Last Update Date | 06/27/2008 |
Identifier | Type | State | Issuer |
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1326106501 | NPI | - | NPPES |
RHM03917G | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | A53357 (California) | Primary |
Krishnamoorthi M. D. Inc., A Professional Medical Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 324 F St, Waterford, CA 95386 Phone: 209-874-2321 Fax: 209-874-3896 | |