Provider Demographics
NPI:1639146376
Name:NEEL, JAMES VANGUNDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VANGUNDIA
Last Name:NEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:V
Other - Last Name:NEEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1120 MONTGOMERY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-578-8355
Mailing Address - Fax:707-578-0334
Practice Address - Street 1:1120 MONTGOMERY DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-578-8355
Practice Address - Fax:707-578-0334
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00C380790208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP107050OtherMEDI CAL CCS
CA00C380790Medicaid
CACGP107050OtherMEDI CAL CCS
CAZZZ28583ZMedicare ID - Type Unspecified