Healthcare Provider Details

I. General information

NPI: 1326365446
Provider Name (Legal Business Name): KATHLEEN MARIE DUBOURDIEU RNP, MN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY MARIE DUBOURDIEU RNP, MN

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2192 MARTIN STE 110
IRVINE CA
92612-1484
US

IV. Provider business mailing address

500 SUPERIOR AVE STE 310
NEWPORT BEACH CA
92663-3609
US

V. Phone/Fax

Practice location:
  • Phone: 949-955-0072
  • Fax:
Mailing address:
  • Phone: 949-644-2722
  • Fax: 949-760-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number429686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: