Provider Demographics
NPI:1861936023
Name:RONDON-FUDINAGA, CESAR L
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:L
Last Name:RONDON-FUDINAGA
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 1:4883 N ASHFORD WAY
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6105
Mailing Address - Country:US
Mailing Address - Phone:734-678-7179
Mailing Address - Fax:
Practice Address - Street 1:4883 N ASHFORD WAY
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-6105
Practice Address - Country:US
Practice Address - Phone:734-678-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036334183500000X
FLPS45928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist