Healthcare Provider Details

I. General information

NPI: 1528060712
Provider Name (Legal Business Name): JOAN M BOESEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W TAFT AVE STE E
ORANGE CA
92865-4249
US

IV. Provider business mailing address

415 W TAFT AVE STE E
ORANGE CA
92865-4249
US

V. Phone/Fax

Practice location:
  • Phone: 714-939-6200
  • Fax: 714-939-6500
Mailing address:
  • Phone: 714-939-6200
  • Fax: 714-939-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: