Provider Demographics
NPI:1427600550
Name:BOCANEGRA, NANCY IVETTE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:IVETTE
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 1:2751 NAPA VALLEY CORPORATE DR BLDG A
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6216
Mailing Address - Country:US
Mailing Address - Phone:707-208-1522
Mailing Address - Fax:
Practice Address - Street 1:1607 CLAY ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3808
Practice Address - Country:US
Practice Address - Phone:707-208-1522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program