Healthcare Provider Details

I. General information

NPI: 1841617529
Provider Name (Legal Business Name): CHIP BOOHER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W COLE BLVD STE B
CALEXICO CA
92231-9700
US

IV. Provider business mailing address

200 S 5TH ST
EL CENTRO CA
92243-3013
US

V. Phone/Fax

Practice location:
  • Phone: 760-890-0190
  • Fax: 760-890-0160
Mailing address:
  • Phone: 760-482-0864
  • Fax: 760-482-9185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number426570
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: