Healthcare Provider Details

I. General information

NPI: 1770730293
Provider Name (Legal Business Name): WILLIAM PAUL BOEHM PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 CAMPUS DRIVE SUITE 550
IRVINE CA
92612
US

IV. Provider business mailing address

3611 MOTOR AVENUE SUITE 240
LOS ANGELES CA
90034
US

V. Phone/Fax

Practice location:
  • Phone: 949-509-6554
  • Fax: 949-509-6599
Mailing address:
  • Phone: 310-837-2444
  • Fax: 310-837-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY11987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: