Healthcare Provider Details

I. General information

NPI: 1013124221
Provider Name (Legal Business Name): CYNDI L. DOUCETTE L.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MORENA BLVD
SAN DIEGO CA
92110-3815
US

IV. Provider business mailing address

1250 MORENA BLVD
SAN DIEGO CA
92110-3815
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8715
  • Fax: 619-542-4969
Mailing address:
  • Phone: 619-692-8715
  • Fax: 619-542-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT26849
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: