Healthcare Provider Details

I. General information

NPI: 1407425929
Provider Name (Legal Business Name): EMMANUEL BOQUIREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 06/19/2021
Certification Date: 06/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EL CAMINO REAL
PALO ALTO CA
94306-3324
US

IV. Provider business mailing address

5700 VILLAGE OAKS DR APT 1315
SAN JOSE CA
95123-3773
US

V. Phone/Fax

Practice location:
  • Phone: 650-565-8090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: