Provider Demographics
NPI:1942441159
Name:BOHACH, REBECCA P (LVN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:BOHACH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 ST. GEORGE
Mailing Address - Street 2:COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629
Mailing Address - Country:US
Mailing Address - Phone:830-672-6511
Mailing Address - Fax:830-672-8608
Practice Address - Street 1:228 ST. GEORGE
Practice Address - Street 2:COMMUNITY HEALTH CENTERS OF SOUTH CENTRAL TEXAS, INC
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629
Practice Address - Country:US
Practice Address - Phone:830-672-6511
Practice Address - Fax:830-672-8608
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133957164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse