Boga Stephane Adogli, RN, PHN
Individual provider Active NPI Registered Nurse · Martinez, CA
NPI 1265770929 · NPPES record last updated Oct 1, 2024
Key facts
- NPI
- 1265770929
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 775390 (CA)
- Practice address
- 25 Allen Street
Martinez, CA 94553 - Phone
- (925) 370-5705
- NPI assigned
- Jan 30, 2013
- 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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 775390 | CA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 775390 | CA | Yes |
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 775390 | CA |
Addresses
Primary practice location
25 Allen Street
Martinez, CA 94553
Mailing address
25 Allen St
Martinez, CA 94553-1337
Phone (925) 370-5705
Other providers in Martinez, CA
- Adaptive Aging
- Kabir Adejare
- Jody Adelberg
- Lilian F Ademola
- Pamela Adhlakha
- Lolita Adona
- Maria Affinito
- Ambika Agarwal
- Namita Atul Agarwal
- Rachel Agron
All providers in Martinez, CA · Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2024. 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.