DON MICHAEL ENDRESS MD NPI 1104145861

NPI Information

  • NPI: 1104145861
  • Provider Name: DON MICHAEL ENDRESS MD
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Doing Business As: DON PEDRO FAMILY PRACTICE
  • CLIA Number: 05D0954551
  • Address: 3191 EL PRADO RD
    SUITE D
    LA GRANGE, CA
    ZIP 95329
  • Phone: (209) 852-2764

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NPI Details

DON MICHAEL ENDRESS MD is a general practice in La Grange, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee DON MICHAEL ENDRESS MD NPI is 1104145861. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Don Pedro Family Practice.

The provider's business location address is:

3191 EL PRADO RD
SUITE D
LA GRANGE, CA
ZIP 95329-761
Phone: (209) 852-2764
Fax: (209) 852-2766

The provider's authorized official is Sandra Marie De La Torre .
The authorized official title is Office Manager and has the following contact phone number (209) 874-2345.

The CLIA number assigned to this NPI record is 05D0954551 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/20/2010 and was last updated on 5/20/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeA53357CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100A533570MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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