Provider Demographics
NPI:1063756054
Name:BOOHER, MARIA CRISTINA (LOT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CRISTINA
Last Name:BOOHER
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16516 LONE WOLF DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3008
Mailing Address - Country:US
Mailing Address - Phone:512-585-9399
Mailing Address - Fax:
Practice Address - Street 1:16516 LONE WOLF DR
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3008
Practice Address - Country:US
Practice Address - Phone:512-585-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100588174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist