Healthcare Provider Details

I. General information

NPI: 1699556399
Provider Name (Legal Business Name): KRISTI BOOGAARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S BREA BLVD UNIT 16
BREA CA
92821-6810
US

IV. Provider business mailing address

509 S BREA BLVD UNIT 16
BREA CA
92821-6810
US

V. Phone/Fax

Practice location:
  • Phone: 714-586-6880
  • Fax:
Mailing address:
  • Phone: 714-586-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: