Provider Demographics
NPI:1205044138
Name:BOESCH, TEAUBIAS HAROLD (RN, FA)
Entity Type:Individual
Prefix:MR
First Name:TEAUBIAS
Middle Name:HAROLD
Last Name:BOESCH
Suffix:
Gender:M
Credentials:RN, FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 E JANICE ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2913
Mailing Address - Country:US
Mailing Address - Phone:562-209-7557
Mailing Address - Fax:
Practice Address - Street 1:336 E JANICE ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2913
Practice Address - Country:US
Practice Address - Phone:562-209-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630269163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant