Provider Demographics
NPI:1508176256
Name:BOXER, OREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:OREN
Middle Name:
Last Name:BOXER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD
Mailing Address - Street 2:MEZZANINE
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2039
Mailing Address - Country:US
Mailing Address - Phone:626-765-4482
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD
Practice Address - Street 2:MEZZANINE
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2039
Practice Address - Country:US
Practice Address - Phone:626-765-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24357103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHM868ZMedicare PIN