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General NPI Number Information
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NPI Number | 1255523569
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Entity Type | Individual
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Provider Name | SUSAN L BOONE M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9201 BIG HORN BLVD 2ND FLOOR
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City | SACRAMENTO
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State | CA
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Zip | 95864
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Country | US
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Telephone | 916-478-5660
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Fax | 916-478-5665
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Provider Business Mailing Address
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Address Line | 9201 BIG HORN BLVD
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City | ELK GROVE
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State | CA
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Zip | 95758-1240
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Country | US
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Telephone | 916-478-5660
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Fax | 916-478-5665
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 125052276
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A118004
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License Number State | CA
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