Provider Demographics
NPI:1518985142
Name:BOUCHARD, MARIA CHRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CHRISTINA
Last Name:BOUCHARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CHRISTINA
Other - Last Name:HARDIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 660879
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-0879
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1600 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3722
Practice Address - Country:US
Practice Address - Phone:805-988-2843
Practice Address - Fax:805-988-2844
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6684207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP6684CMedicare PIN
CAS63562Medicare UPIN