Provider Demographics
NPI:1982240651
Name:DOAN, DUSTINE
Entity type:Individual
Prefix:
First Name:DUSTINE
Middle Name:
Last Name:DOAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 HISTORIC DECATUR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6071
Mailing Address - Country:US
Mailing Address - Phone:858-353-1789
Mailing Address - Fax:
Practice Address - Street 1:2305 HISTORIC DECATUR RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6071
Practice Address - Country:US
Practice Address - Phone:858-353-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator