Provider Demographics
NPI:1740152040
Name:JACQUES COURSEAULT, MD, PC
Entity type:Organization
Organization Name:JACQUES COURSEAULT, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSREAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, CAQSM
Authorized Official - Phone:504-704-1254
Mailing Address - Street 1:20911 EARL ST STE 260
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4360
Mailing Address - Country:US
Mailing Address - Phone:504-704-1254
Mailing Address - Fax:866-572-0930
Practice Address - Street 1:20911 EARL ST STE 260
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4360
Practice Address - Country:US
Practice Address - Phone:504-704-1254
Practice Address - Fax:866-572-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty