Provider Demographics
NPI:1962971788
Name:BOEKELHEIDE, PHILIP GOLDMAN (PA-C)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:GOLDMAN
Last Name:BOEKELHEIDE
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4640 ADMIRALTY WAY
Mailing Address - Street 2:STE 718
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6634
Mailing Address - Country:US
Mailing Address - Phone:310-823-4444
Mailing Address - Fax:310-363-7085
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2434
Practice Address - Country:US
Practice Address - Phone:323-268-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2022-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA56300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant