MEDICARE: MRS. ELLIS PETRONELLA VAN DEN BOOGAARD MS ED., MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	19-109521	CA
2	106S00000X	Behavior Technician	23-294299	CA

General Provider Information

NPI Number	:	1891514824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLIS PETRONELLA VAN DEN BOOGAARD MS ED., MA

Provider Business Mailing Address
First Line	:	251 AIRPORT RD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1201
Country	:	US
Telephone Number	:	760-072-1170
Fax Number	:

Provider Business Practice Location Address
First Line	:	5335 CALLE VIS
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1920
Country	:	US
Telephone Number	:	858-882-7860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

Similar Medicare Providers

1508890021 — DR. FRED KEITH BERGER M.D.
Practice Location Address:

5317 CALLE VIS
SAN DIEGO, CA
92109-1920

Practice Phone: 619-298-3251
Practice Fax: 858-488-8839

1316402712 — ROBERT BASTING
Practice Location Address:

1920 FELSPAR ST APT 4
SAN DIEGO, CA
92109-3522

Practice Phone: 414-614-4611
Practice Fax:

1831237718 — MR. ERIC HOLLANDER L.AC.
Practice Location Address:

7969 ENGINEER RD , SUITE 209
SAN DIEGO, CA
92111-1920

Practice Phone: 858-495-0771
Practice Fax: 858-495-0772

1366870495 — CHANG ACUPUNCTURE & ASSOCIATES, INC.
Practice Location Address:

7969 ENGINEER RD , #209
SAN DIEGO, CA
92111-1920

Practice Phone: 858-495-0771
Practice Fax: 858-630-2923

1275957417 — JEFFREY W BEIMLER L.AC.
Practice Location Address:

7969 ENGINEER RD , STE. #109
SAN DIEGO, CA
92111-1920

Practice Phone: 619-733-1771
Practice Fax: 858-541-1766

1790782175 — MR. HUNG PHI PHAN PHARMACIST
Practice Location Address:

702 E SANTA CLARA ST , SUITE #1
SAN JOSE, CA
95112-1920

Practice Phone: 408-275-0858
Practice Fax: 408-275-0859

Directions to “ MRS. ELLIS PETRONELLA VAN DEN BOOGAARD MS ED., MA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.