Healthcare Provider Details

I. General information

NPI: 1083749733
Provider Name (Legal Business Name): BLANCA DANIELLE BOERSMA BA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 OAK GROVE RD
CONCORD CA
94518-3225
US

IV. Provider business mailing address

3055 PACIFIC AVE #4
SAN FRANCISCO CA
94115-1042
US

V. Phone/Fax

Practice location:
  • Phone: 925-603-1900
  • Fax:
Mailing address:
  • Phone: 510-978-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: