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General NPI Number Information
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NPI Number | 1528224573
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Entity Type | Individual
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Provider Name | MARIENIDA BOEHN PATAM PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 724 S EL CAMINO REAL
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4250
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Country | US
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Telephone | 949-493-6113
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Fax | 949-493-5851
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-579-3203
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA19828
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License Number State | CA
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