Basic Information
| Provider Information | |||||||||
| NPI: | 1285731703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOERO | ||||||||
| FirstName: | SALLY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 BON AIR RD | ||||||||
| Address2: | SUITE 117 | ||||||||
| City: | LARKSPUR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159249770 | ||||||||
| FaxNumber: | 4159248143 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 BON AIR RD | ||||||||
| Address2: | SUITE 117 | ||||||||
| City: | LARKSPUR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159249770 | ||||||||
| FaxNumber: | 4159248143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A64736 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.