Individual
MICHAEL BOESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1330 W WALNUT ST, LODI, CA 95242-3025
(916) 524-3521
Mailing address
2750 E COLLIER RD, ACAMPO, CA 95220-9201
(916) 524-3521
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
397005496
CA
Other
Enumeration date
01/04/2024
Last updated
01/04/2024
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