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General NPI Number Information
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NPI Number | 1669735916
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Entity Type | Individual
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Provider Name | JAMES ANTHONY LOUISELL MD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 1595 SOQUEL DR STE 230
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1721
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Country | US
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Telephone | 831-226-3225
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Fax | 831-423-7579
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Provider Business Mailing Address
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Address Line | 3400 DATA DR ATTN: CREDENTIALING/PAYER ENROLLMENT
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7956
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD182328
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A124140
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD182328
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License Number State | OR
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