Individual
LOUIS BOUCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(570) 903-2785
Mailing address
303 SUGARBERRY CT, JACKSONVILLE, NC 28540-8833
(570) 903-2785
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/22/2024
Last updated
08/22/2024
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