Provider Demographics
NPI:1225250921
Name:BOOMUS, CATHERINE DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:DIANE
Last Name:BOOMUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 YELLOWTAIL DR
Mailing Address - Street 2:
Mailing Address - City:ROSSMOOR
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4847
Mailing Address - Country:US
Mailing Address - Phone:562-355-0540
Mailing Address - Fax:
Practice Address - Street 1:3311 YELLOWTAIL DR
Practice Address - Street 2:
Practice Address - City:ROSSMOOR
Practice Address - State:CA
Practice Address - Zip Code:90720-4847
Practice Address - Country:US
Practice Address - Phone:562-355-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA857022083X0100X
MI43010657562083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine