Provider Demographics
NPI:1093013708
Name:BOISE, MEGA ELENA MARIE (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:MEGA
Middle Name:ELENA MARIE
Last Name:BOISE
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:MEGA
Other - Middle Name:ELENA MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2528 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1614
Mailing Address - Country:US
Mailing Address - Phone:415-469-4988
Mailing Address - Fax:
Practice Address - Street 1:2528 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1614
Practice Address - Country:US
Practice Address - Phone:415-469-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist