Provider Demographics
NPI:1043817638
Name:BOSTANCHYAN, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BOSTANCHYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8874 NIMBUS WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4522
Mailing Address - Country:US
Mailing Address - Phone:916-627-0305
Mailing Address - Fax:916-618-4587
Practice Address - Street 1:8874 NIMBUS WAY
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4522
Practice Address - Country:US
Practice Address - Phone:916-627-0305
Practice Address - Fax:916-618-4587
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342700545310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility