Healthcare Provider Details

I. General information

NPI: 1154746592
Provider Name (Legal Business Name): JEFFREY SANTEE BOYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 RIMPAU AVE STE 214
CORONA CA
92879-7522
US

IV. Provider business mailing address

231 E ALESSANDRO BLVD STE 649
RIVERSIDE CA
92508-5084
US

V. Phone/Fax

Practice location:
  • Phone: 951-206-5150
  • Fax:
Mailing address:
  • Phone: 951-206-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: