Provider Demographics
NPI:1255594057
Name:LOUIE, DON
Entity type:Individual
Prefix:MR
First Name:DON
Middle Name:
Last Name:LOUIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 ENTERPRISE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9447
Mailing Address - Country:US
Mailing Address - Phone:530-621-2055
Mailing Address - Fax:530-621-2311
Practice Address - Street 1:6051 ENTERPRISE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9447
Practice Address - Country:US
Practice Address - Phone:530-621-2055
Practice Address - Fax:530-621-2311
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10052332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780689430OtherNPI
CADME03087FMedicaid
CADME03087FMedicaid