Healthcare Provider Details

I. General information

NPI: 1871708321
Provider Name (Legal Business Name): RANDOLPH STEVEN BOONE PA AND RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 W MORTON AVE
PORTERVILLE CA
93257-1946
US

IV. Provider business mailing address

1119 W MORTON AVE
PORTERVILLE CA
93257-1946
US

V. Phone/Fax

Practice location:
  • Phone: 559-784-4944
  • Fax:
Mailing address:
  • Phone: 559-784-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12253
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP9514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: