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General NPI Number Information
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NPI Number | 1851669741
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Entity Type | Organization
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Legal Business Name | SAN VICENTE WOMEN'S TOTAL HEALTH CENTER INC
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 6310 SAN VICENTE BLVD STE220
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City | LOS ANGELES
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State | CA
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Zip | 90048-5426
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Country | US
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Telephone | 310-274-9977
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Fax | 310-274-0595
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Provider Business Mailing Address
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Address Line | 6310 SAN VICENTE BLVD STE220
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City | LOS ANGELES
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State | CA
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Zip | 90048-5426
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Country | US
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Telephone | 310-274-9977
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Fax | 310-274-0595
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. VIOLET BOODAGHAINS
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Credential | M.D.
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Telephone | 310-274-9977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A044819
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License Number State | CA
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