Provider Demographics
NPI:1922204411
Name:DONLOU, JOHN NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NICHOLAS
Last Name:DONLOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2790 SKYPARK DR
Mailing Address - Street 2:#307
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5300
Mailing Address - Country:US
Mailing Address - Phone:310-539-4489
Mailing Address - Fax:310-326-7759
Practice Address - Street 1:2790 SKYPARK DR
Practice Address - Street 2:#307
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5300
Practice Address - Country:US
Practice Address - Phone:310-539-4489
Practice Address - Fax:319-326-7759
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA247072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83089Medicare UPIN