Osama Boules
Individual provider Active NPI Driver · La Verne, CA
NPI 1215684154 · NPPES record last updated Mar 9, 2022
Key facts
- NPI
- 1215684154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- F6932398 (CA)
- Practice address
- 1860 1St St
La Verne, CA 91750-5307 - Phone
- (626) 586-9773
- Fax
- (626) 249-9191
- NPI assigned
- Mar 9, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F6932398 | CA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | F6932398 | CA | Yes |
Addresses
Primary practice location
1860 1St St
La Verne, CA 91750-5307
Mailing address
1860 1St St
La Verne, CA 91750-5307
Phone (626) 586-9773
Other providers in La Verne, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.