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NPI Code Detail

MEDICARE: WILAIM DAVID BOORMAN PSYCHIATRIC TECHNICI

MEDICARE: WILAIM DAVID BOORMAN PSYCHIATRIC TECHNICI
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
1167G00000XLicensed Psychiatric TechnicianPT 28462CA

General Provider Information

NPI Number : 1235297136
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILAIM DAVID BOORMAN PSYCHIATRIC TECHNICI
Provider Business Mailing Address
First Line : 7455 BALBOA RD
Second Line :
City : ATASCADERO
State : CA
Zip : 93422-1188
Country : US
Telephone Number : 805-466-6206
Fax Number :
Provider Business Practice Location Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-237-3170
Fax Number : 805-226-3207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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Directions to “ WILAIM DAVID BOORMAN PSYCHIATRIC TECHNICI” Practice Location

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