1326163148 NPI number — MICHAEL D DOUCETTE MD PROF CORP

Table of content: MS. SUSAN M PFISTER CARTWRIGHT MA MS PSYS NCSP (NPI 1811235096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326163148 NPI number — MICHAEL D DOUCETTE MD PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL D DOUCETTE MD PROF CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326163148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 N STATE COLLEGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-758-1175
Provider Business Mailing Address Fax Number:
714-758-9201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 N STATE COLLEGE BLVD
Provider Second Line Business Practice Location Address:
ADP MEDICAL GROUP
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-758-1175
Provider Business Practice Location Address Fax Number:
714-758-9201
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOUCETTE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
714-758-1175

Provider Taxonomy Codes

  • Taxonomy code: 261QM3000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com