Icboggan, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

ICBOGGAN, INC

Practice address

3799 Mt Diablo Blvd Unit 200
Lafayette, CA 94549-3545

Phone

(925) 962-7450

NPI assigned

Feb 15, 2020

Organization subpart

No

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

Authorized official

Name

Nerissa T Boggan, RDH

Title

RDH

Phone

(925) 962-7450

Specialties & licenses 2

Addresses

Other names 2

• Nerissa T. Boggan Doing business as
• Orofacial Fitness Doing business as

Locations

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

{
    "created_epoch": "1581724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658620800000",
    "number": "1962035261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3799 MT DIABLO BLVD STE 200",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945493545",
            "telephone_number": "925-962-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3799 MT DIABLO BLVD UNIT 200",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945493545",
            "telephone_number": "925-962-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICBOGGAN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-15",
        "last_updated": "2022-07-24",
        "certification_date": "2022-07-24",
        "status": "A",
        "authorized_official_last_name": "BOGGAN",
        "authorized_official_first_name": "NERISSA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "RDH",
        "authorized_official_telephone_number": "925-962-7450",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nerissa T. Boggan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orofacial Fitness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tracy Lee Hu, MD
• Marilyn Hunt, LMFT
• Austin Gollmer Hurst, PH.D., M.A.
• Lam-Thuy Huynh, MS, OTR/L
• Aisha Ibrahim
• Ide-Don Physical Therapy PC
• Jonathan Ide-Don, P.T.
• Imaging Partners Medical Group
• Nicole Indart
• Allison Inloes, MS, OTR/L

• Specialist in Lafayette, CA
• Providers in Lafayette, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2022; 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.