Individual
WILLIE BENTON BOONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25 TRAMONTO DR, RANCHO PALOS VERDES, CA 90275-5387
(310) 265-9313
(310) 265-8434
Mailing address
25 TRAMONTO DR, RANCHO PALOS VERDES, CA 90275-5387
(310) 265-9313
(310) 265-8434
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G13745
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G137450
—
CA
01
—
G13745
CA LICENSE
CA
01
—
WG13745C
INDIVIDUAL PROVIDER TRANSACTION ACCESS NUMBER (PTAN)
CA
Enumeration date
06/24/2006
Last updated
05/17/2013
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