Healthcare Provider Details

I. General information

NPI: 1376244137
Provider Name (Legal Business Name): BOOST HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 CHERRY WAY
HAYWARD CA
94541-1836
US

IV. Provider business mailing address

943 CHERRY WAY
HAYWARD CA
94541-1836
US

V. Phone/Fax

Practice location:
  • Phone: 510-626-7744
  • Fax:
Mailing address:
  • Phone: 510-626-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: NICOLE SHIH
Title or Position: MANAGER
Credential:
Phone: 510-626-7744