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General NPI Number Information
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NPI Number | 1801996582
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Entity Type | Organization
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Legal Business Name | JULIE G. DUQUETTE M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 2043 WESTCLIFF DR SUITE 302
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5537
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Country | US
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Telephone | 949-515-3462
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Fax | 949-515-4279
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Provider Business Mailing Address
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Address Line | 2043 WESTCLIFF DR SUITE 302
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5537
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Country | US
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Telephone | 949-515-3462
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Fax | 949-515-4279
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Authorized Official
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Title or Position | PRESIDENT, LABORATORY DIRECTOR
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Name | DR. JULIE GAY DUQUETTE
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Credential | M.D.
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Telephone | 949-515-3462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF 11780
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License Number State | CA
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