Provider Demographics
NPI:1811220619
Name:GAMACHE, PAUL D (LAC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:GAMACHE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 FAY AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4265
Mailing Address - Country:US
Mailing Address - Phone:858-459-5900
Mailing Address - Fax:
Practice Address - Street 1:7855 FAY AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4265
Practice Address - Country:US
Practice Address - Phone:858-459-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13199171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist