MEDICARE: MISS AMBER MARIE BOETGER

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1710539184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMBER MARIE BOETGER

Provider Business Mailing Address
First Line	:	3105 TIFFANY DR
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	91752-2834
Country	:	US
Telephone Number	:	909-240-5776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 TIFFANY DR
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	91752-2834
Country	:	US
Telephone Number	:	909-240-5776
Fax Number	:

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

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	07/15/2019

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