Provider Demographics
NPI:1124093000
Name:RAMBERG, DONALD A (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:RAMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 CALIFORNIA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2507
Mailing Address - Country:US
Mailing Address - Phone:805-543-6710
Mailing Address - Fax:805-543-8298
Practice Address - Street 1:699 CALIFORNIA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2507
Practice Address - Country:US
Practice Address - Phone:805-543-6710
Practice Address - Fax:805-543-8298
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56939207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G569390OtherBLUE SHIELD
CA00G569390Medicaid
CAG56939OtherBLUE CROSS
CA184194600OtherDEPT OF LABOR
CA00G569390OtherBLUE SHIELD
CAP00360684Medicare PIN
CAG56939Medicare PIN