Healthcare Provider Details

I. General information

NPI: 1932401957
Provider Name (Legal Business Name): JOHN WILLIAM BOKANOVICH LAADC-CA, CADC-II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E ALISAL ST
SALINAS CA
93901-3519
US

IV. Provider business mailing address

128 E ALISAL ST
SALINAS CA
93901-3519
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-5150
  • Fax: 831-759-2269
Mailing address:
  • Phone: 831-753-5150
  • Fax: 831-759-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCI04420915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: