Provider Demographics
NPI:1922194638
Name:DOUAT, JOSEPH AURELIEN (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:AURELIEN
Last Name:DOUAT
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 1:3202 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5616
Mailing Address - Country:US
Mailing Address - Phone:619-220-7456
Mailing Address - Fax:619-220-7490
Practice Address - Street 1:3202 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5616
Practice Address - Country:US
Practice Address - Phone:619-220-7456
Practice Address - Fax:619-220-7490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA3793171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist