Provider Demographics
NPI:1487763512
Name:ADEMA, DONALD S (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:S
Last Name:ADEMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 MISSION GORGE RD
Mailing Address - Street 2:#M
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071
Mailing Address - Country:US
Mailing Address - Phone:619-596-5445
Mailing Address - Fax:619-596-6923
Practice Address - Street 1:10201 MISSION GORGE RD
Practice Address - Street 2:#M
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071
Practice Address - Country:US
Practice Address - Phone:619-596-5445
Practice Address - Fax:619-596-6923
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ48102ZOtherBLUE SHIELD
CA00AX62390Medicaid
CA20A6239OtherLICENSE
CA20A6239OtherLICENSE
CAW20A6239BMedicare ID - Type Unspecified