Provider Demographics
NPI:1023109048
Name:VONDOLLEN, LAWRENCE E (MD, FACC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:E
Last Name:VONDOLLEN
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:295 POSADA LN
Practice Address - Street 2:STE A
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4055
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:805-782-8859
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44009C207UN0901X, 207UN0901X
CAG44009207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060044244OtherRAILROAD MEDICARE
CAGR0068680Medicaid
CAZZZ28458ZOtherBLUE SHIELD
CAWG44009EMedicare PIN
CAZZZ28458ZOtherBLUE SHIELD
CAGR0068680Medicaid
CAWG44009DMedicare PIN
CA060044244OtherRAILROAD MEDICARE
CAWG44009AMedicare PIN
CAWG44009CMedicare PIN
CAWG4409JMedicare PIN
CAWG44009KMedicare PIN