Organization
DEANE B. JACQUES, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANE B JACQUES M.D. (PRESIDENT)
(626) 414-4094
Entity
Organization
Contact information
Practice address
637 LUCAS AVE, STE. 501, LOS ANGELES, CA 90017-1912
(626) 414-4094
(626) 804-3344
Mailing address
637 LUCAS AVE, STE. 501, LOS ANGELES, CA 90017-1912
(626) 414-4094
(626) 804-3344
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
12/17/2010
Last updated
12/17/2010
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