Individual
ELAINE THERESE VAN GUNDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., F.A.A.P.
Contact information
Practice address
1451 SECRET RAVINE PKWY, SUITE 150, ROSEVILLE, CA 95661-4051
(916) 580-2420
(916) 580-2402
Mailing address
1451 SECRET RAVINE PKWY, SUITE 150, ROSEVILLE, CA 95661-4051
(916) 580-2420
(916) 580-2402
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C43153
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C431530
—
CA
Enumeration date
06/12/2006
Last updated
07/09/2007
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