Nicole Izetta Bostic, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

C55464 Issued in CA

Practice address

9041 Magnolia Ave
Ste. 305
Riverside, CA 92503-3900

Phone

(951) 343-3481

NPI assigned

Jun 4, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: bostic.nicole.005.0050260@amg.meditab.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aspen Medical Group, Inc

  • Obstetrics & Gynecology Physician
  • Riverside, CA
  • NPI 1295821296

  Pediatrics

  NPD (past)
• Aspen Medical Group, Inc.

  • Obstetrics & Gynecology Physician
  • Corona, CA
  • NPI 1225304942

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426636800000",
    "number": "1417159161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 ROADRUNNER DR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928810711",
            "telephone_number": "314-322-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9041 MAGNOLIA AVE",
            "address_2": "STE. 305",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033900",
            "telephone_number": "951-343-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSTIC",
        "first_name": "NICOLE",
        "middle_name": "IZETTA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-04",
        "last_updated": "2015-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2007018726",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C55464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207418500",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Borja
• Edgar Louis Borne III
• Marie Louise Bosin, MA, LMFT
• Sherisee Bossett, LCSW
• Connell Wayne Bost, MD
• Lovie Boston
• Raelynn Boswell
• Lizbeth Botello Orozco
• Monika Botros, PSY.D.
• Tomas Bott

• Pediatrics Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.