Provider Information for 1801453410
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CORINNE BOULGER MA
Sex: Female
NPI: 1801453410
Last Updated: 2024-08-23
Certification Date: 2024-08-23
Certification Date: 2024-08-23
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1801453410 | ||||||||||||
| Enumeration Date | 2019-05-20 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 250 EL CAMINO REAL STE 213 TUSTIN, CA 92780-3656 United States Phone: 714-367-4299 | Fax: | ||||||||||||
| Primary Practice Address | 250 EL CAMINO REAL STE 213 TUSTIN, CA 92780-3656 United States Phone: 714-367-4299 | Fax: | ||||||||||||
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