Provider Demographics
NPI:1003942202
Name:KLUGE, DONALD WAYNE JR
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:KLUGE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 MOUNTAIN VIEW AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3832
Mailing Address - Country:US
Mailing Address - Phone:909-478-9081
Mailing Address - Fax:909-478-9084
Practice Address - Street 1:11306 MOUNTAIN VIEW AVE
Practice Address - Street 2:STE B
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3832
Practice Address - Country:US
Practice Address - Phone:909-478-9081
Practice Address - Fax:909-478-9084
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5609840001Medicare NSC