Healthcare Provider Details

I. General information

NPI: 1952212748
Provider Name (Legal Business Name): CHARLES BOYD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

12560 RIDEABOUT CT
SAN DIEGO CA
92129-3719
US

V. Phone/Fax

Practice location:
  • Phone: 858-834-1798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95260743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: