MEDICARE: DOLORES DIANE DUQUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	164X00000X	Licensed Vocational Nurse	272086	CA

General Provider Information

NPI Number	:	1467177832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLORES DIANE DUQUE

Provider Business Mailing Address
First Line	:	4229 TOYAN DR
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9702
Country	:	US
Telephone Number	:	916-642-7800
Fax Number	:	530-748-3935

Provider Business Practice Location Address
First Line	:	4229 TOYAN DR
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9702
Country	:	US
Telephone Number	:	916-642-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	12/14/2023

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Directions to “ DOLORES DIANE DUQUE ” Practice Location

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