Provider Demographics
NPI:1083463996
Name:BOOCHIE, MARTHA NANETTE (PMHNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:NANETTE
Last Name:BOOCHIE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11228 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-2150
Mailing Address - Country:US
Mailing Address - Phone:562-900-4939
Mailing Address - Fax:
Practice Address - Street 1:9089 BASE LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1295
Practice Address - Country:US
Practice Address - Phone:909-980-3567
Practice Address - Fax:909-989-3932
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95029865363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health