Provider Demographics
NPI:1982902367
Name:DUMOUCHEL, MICHAEL LUCIAN (SRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LUCIAN
Last Name:DUMOUCHEL
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31916 DEL CIELO ESTE APT 32
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-3920
Mailing Address - Country:US
Mailing Address - Phone:760-415-3809
Mailing Address - Fax:
Practice Address - Street 1:31916 DEL CIELO ESTE APT 32
Practice Address - Street 2:
Practice Address - City:BONSALL
Practice Address - State:CA
Practice Address - Zip Code:92003-3920
Practice Address - Country:US
Practice Address - Phone:760-415-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA728283390200000X
MTNUR-APRN-LIC-165777367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program