1093013708 NPI number — MRS. MEGA ELENA MARIE BOISE M.S., CCC

Table of content: MRS. MEGA ELENA MARIE BOISE M.S., CCC (NPI 1093013708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093013708 NPI number — MRS. MEGA ELENA MARIE BOISE M.S., CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOISE
Provider First Name:
MEGA
Provider Middle Name:
ELENA MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
MEGA
Provider Other Middle Name:
ELENA MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093013708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2528 OCEAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94132-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-469-4988
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2528 OCEAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94132-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-469-4988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  18653 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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