Provider Demographics
NPI:1588277909
Name:VON BOECKMANN, MCLEA LUISA PAMELA (MA)
Entity type:Individual
Prefix:
First Name:MCLEA
Middle Name:LUISA PAMELA
Last Name:VON BOECKMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 MOUNT LANGLEY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6912
Mailing Address - Country:US
Mailing Address - Phone:714-450-4118
Mailing Address - Fax:
Practice Address - Street 1:18350 MOUNT LANGLEY ST STE 200
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6912
Practice Address - Country:US
Practice Address - Phone:714-450-4118
Practice Address - Fax:714-378-2631
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker