Healthcare Provider Details

I. General information

NPI: 1447826425
Provider Name (Legal Business Name): ZACHARY BOUCHER ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 CAMINO DEL MAR STE 202
DEL MAR CA
92014-2653
US

IV. Provider business mailing address

2320 NEWPORT AVE
CARDIFF CA
92007-2026
US

V. Phone/Fax

Practice location:
  • Phone: 760-809-1163
  • Fax:
Mailing address:
  • Phone: 760-809-1163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: