Provider Demographics
NPI:1235297136
Name:BOORMAN, WILAIM DAVID (PSYCHIATRIC TECHNICI)
Entity Type:Individual
Prefix:
First Name:WILAIM
Middle Name:DAVID
Last Name:BOORMAN
Suffix:
Gender:M
Credentials:PSYCHIATRIC TECHNICI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 BALBOA RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-1188
Mailing Address - Country:US
Mailing Address - Phone:805-466-6206
Mailing Address - Fax:
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-237-3170
Practice Address - Fax:805-226-3207
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 28462167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician