Individual
SHADY BOULES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
16282 SKYRIDGE DR, RIVERSIDE, CA 92503-0562
(951) 722-0802
Mailing address
16282 SKYRIDGE DR, RIVERSIDE, CA 92503-0562
(951) 722-0802
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95037846
CA
Other
Enumeration date
09/04/2015
Last updated
12/25/2025
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