Healthcare Provider Details

I. General information

NPI: 1780768879
Provider Name (Legal Business Name): MARY ANN BOS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 E FLORENCE AVE
DOWNEY CA
90240
US

IV. Provider business mailing address

8555 E FLORENCE AVE
DOWNEY CA
90240
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-9351
  • Fax: 562-869-6294
Mailing address:
  • Phone: 562-923-9351
  • Fax: 562-869-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number20A7009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: