Healthcare Provider Details

I. General information

NPI: 1760443634
Provider Name (Legal Business Name): EVELYN MARY BOYLE MD., FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S HALCYON RD
ARROYO GRANDE CA
93420-3818
US

IV. Provider business mailing address

150 TEJAS PL PO BOX 430
NIPOMO CA
93444-9123
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-3658
  • Fax:
Mailing address:
  • Phone: 805-929-3211
  • Fax: 805-929-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34614
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA84291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: