Provider Demographics
NPI:1043451313
Name:BOHAN, ELLEN
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BOHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 RUFFIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1699
Mailing Address - Country:US
Mailing Address - Phone:858-694-3500
Mailing Address - Fax:
Practice Address - Street 1:5201 RUFFIN RD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1699
Practice Address - Country:US
Practice Address - Phone:858-694-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator