Individual
EDILITA DE BODA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1535 LOMITA BLVD, HARBOR CITY, CA 90710-2024
(310) 530-9300
Mailing address
1535 LOMITA BLVD, HARBOR CITY, CA 90710-2024
(310) 530-9300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 15259
CA
Other
Enumeration date
10/04/2007
Last updated
05/06/2008
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