Provider Demographics
NPI:1437641289
Name:BOUCARD, ALONIA
Entity Type:Individual
Prefix:
First Name:ALONIA
Middle Name:
Last Name:BOUCARD
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 1:505 S BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-1901
Mailing Address - Country:US
Mailing Address - Phone:951-272-5671
Mailing Address - Fax:
Practice Address - Street 1:505 S BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-1901
Practice Address - Country:US
Practice Address - Phone:951-272-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator