Provider Demographics
NPI:1720198385
Name:DUFOUR, DAVID GILLES (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GILLES
Last Name:DUFOUR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 77790
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0126
Mailing Address - Country:US
Mailing Address - Phone:800-626-2468
Mailing Address - Fax:951-272-9924
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2500
Practice Address - Country:US
Practice Address - Phone:818-788-7500
Practice Address - Fax:818-380-9245
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12099363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12099OtherMEDICAL LICENSE
R40716Medicare UPIN
WPA12099CMedicare ID - Type Unspecified