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NPI Code Detail

MEDICARE: LISA KRISTEN BOOHAR MD

MEDICARE: LISA KRISTEN BOOHAR MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology PhysicianA70556CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063403707
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KRISTEN BOOHAR MD
Provider Business Mailing Address
First Line : 4301 N STAR WAY
Second Line :
City : MODESTO
State : CA
Zip : 95356-9262
Country : US
Telephone Number : 209-342-2300
Fax Number : 209-524-4240
Provider Business Practice Location Address
First Line : 170 ALAMEDA DE LAS PULGAS
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94062-2751
Country : US
Telephone Number : 209-342-2300
Fax Number : 209-524-4240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 12/17/2021

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