Provider Demographics
NPI:1992701080
Name:BOGGELN, LAURENCE HENRY (M D)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:HENRY
Last Name:BOGGELN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27720 JEFFERSON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2630
Mailing Address - Country:US
Mailing Address - Phone:800-797-2050
Mailing Address - Fax:951-848-9500
Practice Address - Street 1:27720 JEFFERSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2630
Practice Address - Country:US
Practice Address - Phone:800-797-2050
Practice Address - Fax:951-848-9500
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG4922207Q00000X
CAG49322207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG49322OtherMEDICAL BOARD OF CALIFORNIA