Healthcare Provider Details

I. General information

NPI: 1003873035
Provider Name (Legal Business Name): MICHELLE L DAUCETT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 E MAIN ST
VENTURA CA
93003-2803
US

IV. Provider business mailing address

PO BOX 60041
ARCADIA CA
91066-6041
US

V. Phone/Fax

Practice location:
  • Phone: 805-667-2841
  • Fax: 805-525-6778
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: