Provider Demographics
NPI:1336685478
Name:BOCANEGRA, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BOCANEGRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 TAHITI DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5315
Mailing Address - Country:US
Mailing Address - Phone:915-238-1202
Mailing Address - Fax:
Practice Address - Street 1:1510 N ZARAGOZA RD STE B1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7976
Practice Address - Country:US
Practice Address - Phone:915-921-6881
Practice Address - Fax:915-921-6882
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107938171W00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235578048OtherTRICARE
TX1235578048OtherAETNA
TX1235578048OtherBLUE CROSS BLUE SHIELD
TX1235578048OtherMOLINA
TX1235578048OtherUNITED HEALTH