| Doctor Name: | MR. DREW EDMUND BOORAM |
| NPI Number: | 1023390358 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ADMINISTRATOR-LIC |
| License Number: | 374601462 |
| Business Practice Address: | 3010 Winters Hl Vista, CA - 920846570 |
| Business Phone Number: | 7609171008 |
| Business Fax Number: | 7605981090 |
| Mailing Address: | 3010 Winters Hl, VISTA |
| State: | CA |
| Postal Code: | 920846570 |
| Phone Number: | 7609171008 |
| Fax Number: | 7605981090 |
| NPI Enumeration Date: | 09/13/2011 |
| NPI Last Update Date: | 09/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | 374601462 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |