Provider Demographics
NPI:1447310107
Name:WELCH, DONAL (AUD)
Entity type:Individual
Prefix:
First Name:DONAL
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20412 BRIAN WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8702
Mailing Address - Country:US
Mailing Address - Phone:661-823-0717
Mailing Address - Fax:661-823-0497
Practice Address - Street 1:20412 BRIAN WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8702
Practice Address - Country:US
Practice Address - Phone:661-823-0717
Practice Address - Fax:661-823-0497
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0012841Medicaid
CAAU0012841Medicaid