Healthcare Provider Details

I. General information

NPI: 1861859928
Provider Name (Legal Business Name): JENNIFER REY BOCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 E BIDWELL ST, STE 200 HANGER CLINIC
FOLSOM CA
95630
US

IV. Provider business mailing address

2575 E BIDWELL ST HANGER CLINIC
FOLSOM CA
95630
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-5606
  • Fax: 916-984-8568
Mailing address:
  • Phone: 916-984-5606
  • Fax: 916-984-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC51500
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: