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General NPI Number Information
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NPI Number | 1003148081
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Entity Type | Organization
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Legal Business Name | JENNIFER R. BOOZER, D.O., INC.
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 1601 MONTE VISTA AVE SUITE 260
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City | CLAREMONT
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State | CA
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Zip | 91711-2962
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Country | US
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Telephone | 909-450-1571
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Fax | 909-579-0100
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Provider Business Mailing Address
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Address Line | 1601 MONTE VISTA AVE SUITE 260
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City | CLAREMONT
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State | CA
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Zip | 91711-2962
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Country | US
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Telephone | 909-450-1571
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Fax | 909-579-0100
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNIFER ROSE BOOZER
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Credential | D.O.
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Telephone | 909-450-1571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2OA8927
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License Number State | CA
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