Provider Demographics
NPI:1215600028
Name:BOATNER, SALINA
Entity type:Individual
Prefix:
First Name:SALINA
Middle Name:
Last Name:BOATNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 CONCANNON DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3055
Mailing Address - Country:US
Mailing Address - Phone:925-679-4598
Mailing Address - Fax:
Practice Address - Street 1:1786 CONCANNON DR
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3055
Practice Address - Country:US
Practice Address - Phone:925-679-4598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA079201079310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility