Healthcare Provider Details

I. General information

NPI: 1205745411
Provider Name (Legal Business Name): CLARA BOJORQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 W 14TH ST
SAN PEDRO CA
90731-4396
US

IV. Provider business mailing address

233 N HANFORD AVE
SAN PEDRO CA
90732-2904
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-8723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number714053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: