| Judy L Bourget Md Inc | |
|
34052 La Plz Ste 104 Dana Point CA 92629-2587 | |
| (949) 429-8760 | |
| (949) 429-6909 |
| Full Name | Judy L Bourget Md Inc |
|---|---|
| Speciality | General Practice |
| Location | 34052 La Plz, Dana Point, California |
| Authorized Official Name and Position | Judy L Bourget (OWNER) |
| Authorized Official Contact | 9494298760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Judy L Bourget Md Inc 34052 La Plz Ste 104 Dana Point CA 92629-2587 Ph: (949) 429-8760 | Judy L Bourget Md Inc 34052 La Plz Ste 104 Dana Point CA 92629-2587 Ph: (949) 429-8760 |
| NPI Number | 1609181668 |
|---|---|
| Provider Enumeration Date | 08/16/2010 |
| Last Update Date | 08/16/2010 |
| Medicare PECOS PAC ID | 3577697986 |
|---|---|
| Medicare Enrollment ID | O20100819000941 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609181668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | G72076 (California) | Primary |
| Provider Name | Judy L Bourget |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1073593240 PECOS PAC ID: 0244288397 Enrollment ID: I20050105001063 |
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