Provider Demographics
NPI:1366848517
Name:JOHN DESNOYERS MD, INC.
Entity Type:Organization
Organization Name:JOHN DESNOYERS MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESNOYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-461-1898
Mailing Address - Street 1:PO BOX 90544
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92169-2544
Mailing Address - Country:US
Mailing Address - Phone:619-461-1898
Mailing Address - Fax:619-461-0198
Practice Address - Street 1:4370 LA JOLLA VILLAGE DR
Practice Address - Street 2:400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1249
Practice Address - Country:US
Practice Address - Phone:619-461-1898
Practice Address - Fax:619-461-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81907207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty