Provider Demographics
NPI:1780678706
Name:KONDOVSKI, SACHO RADE (DO)
Entity type:Individual
Prefix:DR
First Name:SACHO
Middle Name:RADE
Last Name:KONDOVSKI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1095 MARSHALL WAY
Mailing Address - Street 2:STE 100,201,202,203
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5722
Mailing Address - Country:US
Mailing Address - Phone:530-626-2920
Mailing Address - Fax:
Practice Address - Street 1:28780 SINGLE OAK DR
Practice Address - Street 2:SUITE 160
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3625
Practice Address - Country:US
Practice Address - Phone:951-676-4193
Practice Address - Fax:951-719-1469
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6077OtherLICENSE
CABK2783377OtherDEA
CA20A6077OtherLICENSE
CAF60907Medicare UPIN