Provider Demographics
NPI:1225194392
Name:FOURNIER, ALINE GISELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALINE
Middle Name:GISELLE
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S IVY ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4337
Mailing Address - Country:US
Mailing Address - Phone:760-746-1133
Mailing Address - Fax:760-746-9880
Practice Address - Street 1:307 S IVY ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4337
Practice Address - Country:US
Practice Address - Phone:760-746-1133
Practice Address - Fax:760-746-9880
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6063204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX60036Medicaid
CA20A6063CMedicare ID - Type Unspecified
CA00AX60036Medicaid