Healthcare Provider Details

I. General information

NPI: 1497758171
Provider Name (Legal Business Name): WILLIAM DOUGLAS BOCASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2486 N PONDEROSA DR STE D211
CAMARILLO CA
93010-2376
US

IV. Provider business mailing address

2486 N PONDEROSA DR STE D211
CAMARILLO CA
93010-2376
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-2818
  • Fax: 805-482-0028
Mailing address:
  • Phone: 805-484-2818
  • Fax: 805-482-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG058470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: