Healthcare Provider Details

I. General information

NPI: 1578996203
Provider Name (Legal Business Name): RENEE MAXINE BOEHME PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE MAXINE HERNANDEZ

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28050 ROAD 148
VISALIA CA
93292-9297
US

IV. Provider business mailing address

28050 ROAD 148
VISALIA CA
93292-9297
US

V. Phone/Fax

Practice location:
  • Phone: 559-730-7422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240310803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: