Provider Demographics
NPI:1801996582
Name:JULIE G. DUQUETTE M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:JULIE G. DUQUETTE M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:DUQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-515-3462
Mailing Address - Street 1:2043 WESTCLIFF DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5537
Mailing Address - Country:US
Mailing Address - Phone:949-515-3462
Mailing Address - Fax:949-515-4279
Practice Address - Street 1:2043 WESTCLIFF DR
Practice Address - Street 2:SUITE 302
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5537
Practice Address - Country:US
Practice Address - Phone:949-515-3462
Practice Address - Fax:949-515-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 11780291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1010850OtherCLIA NUMBER
CACLF 11780OtherCALIFORNIA LABORATORY LIC
G74262Medicare ID - Type Unspecified