Healthcare Provider Details

I. General information

NPI: 1285095786
Provider Name (Legal Business Name): JOSCELYN BOUDREAU MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 FREDERICK ST STE 103
SANTA CRUZ CA
95062-2239
US

IV. Provider business mailing address

700 FREDERICK ST STE 103
SANTA CRUZ CA
95062-2239
US

V. Phone/Fax

Practice location:
  • Phone: 831-316-4358
  • Fax:
Mailing address:
  • Phone: 831-996-1222
  • Fax: 831-417-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: