Healthcare Provider Details

I. General information

NPI: 1801634704
Provider Name (Legal Business Name): PATRICIA BOYLE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA FORTNEY

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 WILSHIRE BLVD FL 19
LOS ANGELES CA
90048-4920
US

IV. Provider business mailing address

10887 SONORA AVE
RANCHO CUCAMONGA CA
91701-4441
US

V. Phone/Fax

Practice location:
  • Phone: 805-764-9651
  • Fax: 747-330-1670
Mailing address:
  • Phone: 805-764-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95031625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: