Provider Demographics
NPI:1497901680
Name:DANDURAND, JOHN M (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:DANDURAND
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12927 SLEEPY WIND ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2935
Mailing Address - Country:US
Mailing Address - Phone:310-989-3092
Mailing Address - Fax:805-530-3989
Practice Address - Street 1:740 LOMAS SANTA FE DR
Practice Address - Street 2:STE. 110
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1495
Practice Address - Country:US
Practice Address - Phone:858-259-4182
Practice Address - Fax:858-259-4853
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2056237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497901680Medicaid