Individual
ELLEN MARIE DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10121 PINE AVE, TRUCKEE, CA 96161-4856
(510) 307-6773
Mailing address
10 ARCH ST APT 204, REDWOOD CITY, CA 94062-1402
(510) 307-6773
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A151834
CA
208000000X
Pediatrics Physician
A151834
CA
Other
Enumeration date
02/02/2015
Last updated
06/08/2023
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