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General NPI Number Information
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NPI Number | 1154416451
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Entity Type | Individual
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Provider Name | NANCY SUMIRE BOERNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 31872 COAST HWY
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6773
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Country | US
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Telephone | 949-499-7645
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Fax | 949-499-7532
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Provider Business Mailing Address
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Address Line | 28821 VIA BUENA VISTA
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-5556
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Country | US
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Telephone | 949-499-7645
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Fax | 949-489-9981
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A044509
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License Number State | CA
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