Organization
JEFFREY M. JOHNSRUD, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA FUENTES (CREDENTIALING)
(714) 619-5450
Entity
Organization
Contact information
Practice address
1140 W LA VETA AVE, SUITE 760, ORANGE, CA 92868-4223
(714) 541-4442
(714) 835-9550
Mailing address
1140 W LA VETA AVE, SUITE 760, ORANGE, CA 92868-4223
(714) 541-4442
(714) 835-9550
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G51096
CA
Other
Enumeration date
11/03/2010
Last updated
03/31/2011
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