Healthcare Provider Details

I. General information

NPI: 1346977998
Provider Name (Legal Business Name): LORENA BOYZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST
LOMA LINDA CA
92357-3678
US

IV. Provider business mailing address

PO BOX 1009
LOMA LINDA CA
92354-1009
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04383
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: