Provider Demographics
NPI:1275205940
Name:DEMOULPIED, COLE THOMAS (CORPSMAN)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:THOMAS
Last Name:DEMOULPIED
Suffix:
Gender:M
Credentials:CORPSMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 OLD QUARRY RD
Mailing Address - Street 2:UNIT 2232
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:231-632-4574
Mailing Address - Fax:
Practice Address - Street 1:2587 OLD QUARRY RD
Practice Address - Street 2:UNIT 2232
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:231-632-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
DED541122792699Medicaid
CA123456789Medicaid