MEDICARE: DR. DAVID ALAN BOUCHER PH.D.

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	103T00000X	Psychologist	PSY14085	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518966340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALAN BOUCHER PH.D.

Provider Business Mailing Address
First Line	:	3633 CAMINO DEL RIO SOUTH
Second Line	:	SUITE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4012
Country	:	US
Telephone Number	:	619-296-8097
Fax Number	:	619-260-1036

Provider Business Practice Location Address
First Line	:	3633 CAMINO DEL RIO SOUTH
Second Line	:	SUITE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4012
Country	:	US
Telephone Number	:	619-296-8097
Fax Number	:	619-260-1036

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	02/28/2011

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