Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G70017 | CA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 04-39813 | KS |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | G70017 | CA |
NPI | 1972569531 |
---|---|
Provider Name | Dr. Jennette Boakes |
First Address | Los Angeles, CA 90084-5212 |
Second Address | Sacramento, CA 95817-2215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 28/08/2017 |