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General NPI Number Information
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NPI Number | 1225250921
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Entity Type | Individual
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Provider Name | CATHERINE DIANE BOOMUS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 3311 YELLOWTAIL DR
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City | ROSSMOOR
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State | CA
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Zip | 90720-4847
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Country | US
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Telephone | 562-355-0540
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Fax |
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Provider Business Mailing Address
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Address Line | 3311 YELLOWTAIL DR
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City | ROSSMOOR
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State | CA
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Zip | 90720-4847
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Country | US
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Telephone | 562-355-0540
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | A85702
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 4301065756
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License Number State | MI
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