Provider Demographics
NPI:1427364215
Name:DAVID L HAUGEN, M.D., INC.
Entity Type:Organization
Organization Name:DAVID L HAUGEN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOESCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-367-4193
Mailing Address - Street 1:15366 DE LA CRUZ DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MURIETA
Mailing Address - State:CA
Mailing Address - Zip Code:95683-9719
Mailing Address - Country:US
Mailing Address - Phone:916-354-4100
Mailing Address - Fax:530-367-2974
Practice Address - Street 1:15366 DE LA CRUZ DR
Practice Address - Street 2:
Practice Address - City:RANCHO MURIETA
Practice Address - State:CA
Practice Address - Zip Code:95683-9719
Practice Address - Country:US
Practice Address - Phone:916-354-4100
Practice Address - Fax:530-367-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00C313243208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C313240Medicaid
CA00C313243Medicare PIN