Randy Lee Boeglin Jr.
Technician, Attendant Care Provider in Rancho Cucamonga, CA. Individual provider (NPI-1).
NPI number1790322964
StatusActive
Last updated in NPPESSep 15, 2021
Details
- NPI
- 1790322964
- Entity type
- Individual (NPI-1)
- Name
- Randy Lee Boeglin Jr.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 5, 2019
- Certification date
- Sep 15, 2021
- Last updated
- Sep 15, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3747A0650X | Technician, Attendant Care Provider | – | – | Yes |
Practice location
7334 Cascade CtRancho Cucamonga, CA 91730-6732
Phone 714-833-8955
Mailing address
7334 Cascade CtRancho Cucamonga, CA 91730-6732
Phone 714-833-8955
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