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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Fred Henry Rundall | [sources] | |||
| Other name | Rundall, Frederick | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| First name | Fred | [sources] | |||
| Last name | Rundall | [sources] | |||
| Middle name | Henry | [sources] | |||
| NPI | 1225049331 · 1295746394 | [sources] | |||
| Registration number | 00G504820 · 00G504821 · 00G504822 · G50482 · GR0086530 · | [sources] | |||
| Sector | Physician | [sources] | |||
| Address | 39478 Butterfly Dr., NE, Yucaipa, CA, 92399 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States of America · DHCS
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