Nicole Izetta Bostic
MD | Pediatrics | Female
Nicole Izetta Bostic, MD is a Riverside, California based Pediatric doctor with medical specialization in
General Pediatrics.
Current practice location of Nicole Izetta Bostic is
9041 Magnolia Ave, Ste. 305, Riverside, California - 92503-3900. She can be contacted on phone at
951-343-3481.
Nicole Izetta Bostic is a sole proprietor of her business.
NPI number (Unique professional ID) for Nicole Izetta Bostic is
1417159161 which was assigned by NPPES on 04 Jun, 2007 and it was last updated on 18 Mar, 2015.
Nicole Izetta Bostic license number is
C55464 for Pediatrics (208000000X) in California.
Nicole Izetta Bostic is a pediatrician who is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Complete Profile:
Nicole Izetta Bostic basic information including her official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics |
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| Provider Name : | Nicole Izetta Bostic |
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| Credential : | MD |
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| Gender : | Female |
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| Sole Proprietor : | Yes |
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Business Address:
Nicole Izetta Bostic address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 9041 Magnolia Ave, Ste. 305
Riverside, CA, 92503-3900
United States |
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| Phone Number : | 951-343-3481 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1417159161 |
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| NPI Entity Type : | Individual |
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| First Enrolment Date : | 04 Jun, 2007 |
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| Last Updated On : | 18 Mar, 2015 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Nicole Izetta Bostic are as mentioned. Primary taxonomy code for Nicole Izetta Bostic, MD is
208000000X (Pediatrics).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 208000000X | Pediatrics | No | 2007018726 | MO |
| 208000000X | Pediatrics | Yes | C55464 | CA |
Legacy Identifiers:
Other legacy medical identifiers of Nicole Izetta Bostic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 207418500 | MEDICAID | MO | |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | 1412 Roadrunner Dr
Corona, CA, 92881-0711
United States |
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| Phone Number : | 314-322-2056 |
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Business Location:
Patients can refer following map for directions to
Nicole Izetta Bostic practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.