Individual
ALEX JOHN DETURCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1255 KENDALL RD, SAN LUIS OBISPO, CA 93401-8750
(805) 781-3535
Mailing address
1117 VISTA DEL LAGO, SAN LUIS OBISPO, CA 93405-4832
(650) 474-1266
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
CA
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/29/2021
Last updated
04/20/2023
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