Provider Demographics
NPI:1437430329
Name:KRISTEN BOMAS P.A.
Entity Type:Organization
Organization Name:KRISTEN BOMAS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-725-7200
Mailing Address - Street 1:810 SE 8TH AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:954-725-7200
Mailing Address - Fax:
Practice Address - Street 1:810 SE 8TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5623
Practice Address - Country:US
Practice Address - Phone:954-725-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty