Provider Demographics
NPI:1710358395
Name:BOGGS, PHILLIP (AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:BOGGS
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-1088
Mailing Address - Country:US
Mailing Address - Phone:562-869-1070
Mailing Address - Fax:562-286-8777
Practice Address - Street 1:10441 LAKEWOOD BLVD STE AB
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2744
Practice Address - Country:US
Practice Address - Phone:562-869-1070
Practice Address - Fax:562-286-8777
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003204363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care