Healthcare Provider Details

I. General information

NPI: 1114614708
Provider Name (Legal Business Name): MANUEL LOUIS DOUROUX II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7859 FIRESTONE BLVD
DOWNEY CA
90241-4220
US

IV. Provider business mailing address

7859 FIRESTONE BLVD
DOWNEY CA
90241-4220
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-8890
  • Fax: 562-861-5418
Mailing address:
  • Phone: 562-869-8890
  • Fax: 562-861-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number88302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: