Provider Demographics
NPI:1003234998
Name:BOKTOR, NEVINE
Entity Type:Individual
Prefix:
First Name:NEVINE
Middle Name:
Last Name:BOKTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20475 YELLOW BRICK RD
Mailing Address - Street 2:3A
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2929
Mailing Address - Country:US
Mailing Address - Phone:909-594-9054
Mailing Address - Fax:909-594-3736
Practice Address - Street 1:20475 YELLOW BRICK RD
Practice Address - Street 2:3A
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2929
Practice Address - Country:US
Practice Address - Phone:909-594-9054
Practice Address - Fax:909-594-3736
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver