Healthcare Provider Details

I. General information

NPI: 1194910455
Provider Name (Legal Business Name): BOONCLAIRE SIENGTHAI PAPALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOONCLAIRE SIENGTHAI MD

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT ST 3RD FLOOR - PHRS
PASADENA CA
91188-0001
US

IV. Provider business mailing address

322 E THOUSAND OAKS BLVD SUITE 100
THOUSAND OAKS CA
91360-5804
US

V. Phone/Fax

Practice location:
  • Phone: 626-405-7914
  • Fax:
Mailing address:
  • Phone: 888-515-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA95288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: