Provider Demographics
NPI:1982194379
Name:BOATMAN, WESLEY JAMES
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:JAMES
Last Name:BOATMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 VIA CORTEZ
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2144
Mailing Address - Country:US
Mailing Address - Phone:805-742-6067
Mailing Address - Fax:
Practice Address - Street 1:1236 CHAPALA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3116
Practice Address - Country:US
Practice Address - Phone:805-741-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor