=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134259054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD BOGGS FNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1315 ALHAMBRA BLVD STE 210
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95816-5246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-732-4380
-----------------------------------------------------
Fax | 916-739-0893
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9756 JUTLAND CT
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95757-3259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-478-4271
-----------------------------------------------------
Fax | 916-478-4271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1065185
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 15753
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------