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General NPI Number Information
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NPI Number | 1083463996
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Entity Type | Individual
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Provider Name | MARTHA NANETTE BOOCHIE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 05/14/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 9089 BASE LINE RD STE 200
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1295
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Country | US
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Telephone | 909-980-3567
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Fax | 909-989-3932
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Provider Business Mailing Address
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Address Line | 11228 NASHVILLE AVE
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City | WHITTIER
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State | CA
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Zip | 90604-2150
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Country | US
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Telephone | 562-900-4939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95029865
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License Number State | CA
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