Provider Demographics
NPI:1659188803
Name:HODGES BOOTEN, TONI DENISE
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:DENISE
Last Name:HODGES BOOTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:BOOTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11681 STERLING AVE STE I
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4972
Mailing Address - Country:US
Mailing Address - Phone:951-729-6282
Mailing Address - Fax:
Practice Address - Street 1:11681 STERLING AVE STE I
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4972
Practice Address - Country:US
Practice Address - Phone:951-729-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker