Provider Demographics
NPI:1295183002
Name:BOER, CARA (CO)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:BOER
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7863 LA MESA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0671
Mailing Address - Country:US
Mailing Address - Phone:619-589-9980
Mailing Address - Fax:619-589-9988
Practice Address - Street 1:7863 LA MESA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0671
Practice Address - Country:US
Practice Address - Phone:619-589-9980
Practice Address - Fax:619-589-9988
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95-3731127222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist