Individual
LUCIENNE SIMONE BOUVIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
85 SIERRA PARK RD, MAMMOTH LAKES, CA 93546-2073
(760) 934-3311
Mailing address
85 SIERRA PARK RD, MAMMOTH LAKES, CA 93546-2073
(760) 932-3311
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G79050
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G790500
—
CA
Enumeration date
11/02/2006
Last updated
05/28/2021
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