Provider Demographics
NPI:1528844636
Name:REBECCA R BOENING MD INC
Entity type:Organization
Organization Name:REBECCA R BOENING MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOENING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-934-8700
Mailing Address - Street 1:263 N VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2607
Mailing Address - Country:US
Mailing Address - Phone:530-934-8700
Mailing Address - Fax:
Practice Address - Street 1:263 N VILLA AVE
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2607
Practice Address - Country:US
Practice Address - Phone:530-934-8700
Practice Address - Fax:530-934-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty