Provider Demographics
NPI:1205213170
Name:AUBIN-POULIOT, ANNICK
Entity Type:Individual
Prefix:
First Name:ANNICK
Middle Name:
Last Name:AUBIN-POULIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 4TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3661
Mailing Address - Country:US
Mailing Address - Phone:707-523-7025
Mailing Address - Fax:707-523-3024
Practice Address - Street 1:1701 4TH ST STE 120
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3661
Practice Address - Country:US
Practice Address - Phone:707-523-7025
Practice Address - Fax:707-523-3024
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA145844207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology