Healthcare Provider Details

I. General information

NPI: 1235073081
Provider Name (Legal Business Name): OCTAYANNA BOUCAUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8837 BURNET AVE APT 111
NORTH HILLS CA
91343-5667
US

IV. Provider business mailing address

8837 BURNET AVE APT 111
NORTH HILLS CA
91343-5667
US

V. Phone/Fax

Practice location:
  • Phone: 929-884-2242
  • Fax:
Mailing address:
  • Phone: 929-884-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: