Basic Information
Provider Information | |||||||||
NPI: | 1598727216 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BOOR | ||||||||
FirstName: | AARON | ||||||||
MiddleName: | BRADLEY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 EMBARCADERO CTR STE 1900 | ||||||||
Address2: |   | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941113723 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4156586791 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 26741 ALISO CREEK RD STE F | ||||||||
Address2: |   | ||||||||
City: | ALISO VIEJO | ||||||||
State: | CA | ||||||||
PostalCode: | 926564804 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9498998309 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/06/2006 | ||||||||
LastUpdateDate: | 09/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DOS-1872 | HI | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 3594 | AZ | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 18507 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.