Edilita De Boda, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA 15259 Issued in CA

Practice address

1535 Lomita Blvd
Harbor City, CA 90710-2024

Phone

(310) 530-9300

NPI assigned

Oct 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

• St. Isabel Family Medical Clinic, Inc.

  • Primary Care Clinic/Center
  • Harbor City, CA
  • NPI 1700057981
  NPD (past) Authorized official

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210032000000",
    "number": "1982892956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 LOMITA BLVD",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907102024",
            "telephone_number": "310-530-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 LOMITA BLVD",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907102024",
            "telephone_number": "310-530-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE BODA",
        "first_name": "EDILITA",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-04",
        "last_updated": "2008-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA 15259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret J. David, MD
• Lalisa Davidson, RCP
• Marie Lynn Davies, PHARMD
• Pargev Davtian, DDS
• Lenny Nabong Dayrit, DDS
• Sandra Elizabeth De Guzman, CERTIFIED NURSE MIDW
• Vanessa De la Torre, LCSW
• Amar S Dean
• Rebecca Marie Deans, M.D.
• Nancy Delaroca, CRNA

• Medical Physician Assistant in Harbor City, CA
• Providers in Harbor City, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.