Healthcare Provider Details

I. General information

NPI: 1316687577
Provider Name (Legal Business Name): AUJANAE BOATNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 NOOR AVE STE B
SOUTH SAN FRANCISCO CA
94080-5929
US

IV. Provider business mailing address

470 NOOR AVE STE B
SOUTH SAN FRANCISCO CA
94080-5929
US

V. Phone/Fax

Practice location:
  • Phone: 888-985-5455
  • Fax: 877-985-7622
Mailing address:
  • Phone: 888-985-5455
  • Fax: 877-985-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: