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Organization
THEODORE VANDAM M.D.
Active
Organization
THEODORE VANDAM M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE VANDAM M.D. (PRESIDENT)
(949) 240-6772
Entity
Organization
Contact information
Practice address
665 CAMINO DE LOS MARES, STE 210, SAN CLEMENTE, CA 92673-2859
(949) 240-6772
(949) 240-6841
Mailing address
665 CAMINO DE LOS MARES, STE 210, SAN CLEMENTE, CA 92673-2859
(949) 240-6772
(949) 240-6841
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A24788
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A247880
—
CA
Enumeration date
06/08/2007
Last updated
07/28/2010
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