MEDICARE: BRIAN BOQUIREN

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
1	183500000X	Pharmacist	60199	CA

General Provider Information

NPI Number	:	1124441134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN BOQUIREN

Provider Business Mailing Address
First Line	:	811 AVENIDA TALEGA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6523
Country	:	US
Telephone Number	:	949-940-0167
Fax Number	:	949-940-1051

Provider Business Practice Location Address
First Line	:	811 AVENIDA TALEGA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6523
Country	:	US
Telephone Number	:	949-940-0167
Fax Number	:	949-940-1051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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Directions to “ BRIAN BOQUIREN ” Practice Location

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