Individual
JEFFREY M JOHNSRUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1140 W LA VETA AVE, #760, ORANGE, CA 92868-4223
(714) 541-4442
(714) 835-9550
Mailing address
1140 W LA VETA AVE, #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
11/20/2006
Last updated
10/27/2011
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