Provider Demographics
NPI:1447826425
Name:BOUCHER, ZACHARY (ND)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:BOUCHER
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2026
Mailing Address - Country:US
Mailing Address - Phone:760-809-1163
Mailing Address - Fax:
Practice Address - Street 1:1011 CAMINO DEL MAR STE 202
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2653
Practice Address - Country:US
Practice Address - Phone:760-809-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1211175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty