Provider Demographics
NPI:1568491025
Name:LOUIS, JOANNA ROBERTA (MD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:ROBERTA
Last Name:LOUIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0151
Mailing Address - Country:US
Mailing Address - Phone:760-809-3388
Mailing Address - Fax:760-943-1523
Practice Address - Street 1:1853 N VULCAN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1151
Practice Address - Country:US
Practice Address - Phone:760-809-3388
Practice Address - Fax:760-943-1523
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG043299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49304Medicare UPIN