Provider Demographics
NPI:1902915788
Name:JORETEG, DAVID LENNART
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LENNART
Last Name:JORETEG
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:PO BOX 9356
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-2556
Mailing Address - Country:US
Mailing Address - Phone:909-793-3434
Mailing Address - Fax:909-802-7916
Practice Address - Street 1:11519 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-6715
Practice Address - Country:US
Practice Address - Phone:909-793-3434
Practice Address - Fax:909-802-7916
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment