Healthcare Provider Details

I. General information

NPI: 1699191437
Provider Name (Legal Business Name): NICHOLAS DAUCHOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 BROADWAY STE 610
OAKLAND CA
94612-2026
US

IV. Provider business mailing address

1440 BROADWAY STE 610
OAKLAND CA
94612-2026
US

V. Phone/Fax

Practice location:
  • Phone: 310-987-0745
  • Fax:
Mailing address:
  • Phone: 310-987-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: