Provider Demographics
NPI:1215643465
Name:BOAZ, RENEE ELENA (NP-C)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ELENA
Last Name:BOAZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 VARIEL AVE APT 443
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4808
Mailing Address - Country:US
Mailing Address - Phone:818-383-8144
Mailing Address - Fax:
Practice Address - Street 1:17075 DEVONSHIRE ST STE 209
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5411
Practice Address - Country:US
Practice Address - Phone:818-832-7805
Practice Address - Fax:818-832-7802
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily