Active NPI
Peter Kwaku Boateng, RN
- Psychiatric/Mental Health Registered Nurse
- Glendale, CA
National Provider Identifier
1639784515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Registered Nurse
- License
- 603068
- Practice address
- 1509 Wilson Ter
Glendale, CA 91206-4007 - Phone
- (818) 409-8000
- NPI assigned
- Sep 9, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 603068 | CA | Primary |
Addresses
Primary practice location
1509 Wilson Ter
Glendale, CA 91206-4007
Mailing address
7903 Elm Ave Apt 312
Rancho Cucamonga, CA 91730-6854
Phone (323) 854-1216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 603068 | CA | MD | Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599609600000",
"number": "1639784515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7903 ELM AVE APT 312",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917306854",
"telephone_number": "323-854-1216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1509 WILSON TER",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912064007",
"telephone_number": "818-409-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOATENG",
"first_name": "PETER",
"middle_name": "KWAKU",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-09",
"last_updated": "2020-09-09",
"certification_date": "2020-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "CA",
"license": "603068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.