Provider Demographics
NPI:1215472576
Name:BOCTOR NAKHLA, MARENA (DPT)
Entity type:Individual
Prefix:
First Name:MARENA
Middle Name:
Last Name:BOCTOR NAKHLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARENA
Other - Middle Name:
Other - Last Name:BOCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:31271 NIGUEL RD STE J
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4135
Mailing Address - Country:US
Mailing Address - Phone:949-443-5442
Mailing Address - Fax:949-443-5436
Practice Address - Street 1:31271 NIGUEL RD STE J
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4135
Practice Address - Country:US
Practice Address - Phone:949-443-5442
Practice Address - Fax:949-443-5436
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29549225100000X
CA292549208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA292549OtherPT LICENSE