Individual
DR. MARY LUCILLE BOEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1455 MONTEGO, #104, WALNUT CREEK, CA 94598-2990
(925) 946-1711
(925) 946-1902
Mailing address
DEPT 34929, P.O. BOX 39000, SAN FRANCISCO, CA 94139-0001
(925) 952-2828
(925) 952-2850
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
G61295
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G612950
—
CA
Enumeration date
03/27/2007
Last updated
06/17/2012
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