Provider Demographics
NPI:1215971999
Name:BURINGRUD, DUANE
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:BURINGRUD
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 1:488 E VALLEY PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3363
Mailing Address - Country:US
Mailing Address - Phone:760-745-1363
Mailing Address - Fax:
Practice Address - Street 1:488 E VALLEY PKWY
Practice Address - Street 2:SUITE 308
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-9998
Practice Address - Country:US
Practice Address - Phone:760-745-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34140207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330322941OtherTRICARE
CAW14158OtherNHC GROUP PTAN
CA00G341400OtherBLUE SHIELD
CA00G341400Medicaid
CACV948YMedicare UPIN
CAA45799Medicare UPIN
CAWG34140BMedicare ID - Type Unspecified