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General NPI Number Information
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NPI Number | 1366848517
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Entity Type | Organization
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Legal Business Name | JOHN DESNOYERS MD, INC.
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 4370 LA JOLLA VILLAGE DR 400
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City | SAN DIEGO
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State | CA
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Zip | 92122-1249
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Country | US
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Telephone | 619-461-1898
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Fax | 619-461-0198
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Provider Business Mailing Address
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Address Line | PO BOX 90544
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City | SAN DIEGO
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State | CA
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Zip | 92169-2544
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Country | US
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Telephone | 619-461-1898
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Fax | 619-461-0198
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN DESNOYERS
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Credential | MD
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Telephone | 619-461-1898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G81907
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License Number State | CA
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