Provider Demographics
NPI:1740464551
Name:VOLDENG, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:VOLDENG
Suffix:
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 1:1040 ELM AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3265
Mailing Address - Country:US
Mailing Address - Phone:562-491-2145
Mailing Address - Fax:562-491-0153
Practice Address - Street 1:1040 ELM AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3265
Practice Address - Country:US
Practice Address - Phone:562-491-2145
Practice Address - Fax:562-491-0153
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15918363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical