Healthcare Provider Details

I. General information

NPI: 1578262457
Provider Name (Legal Business Name): JUSTIN BOSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR
OXNARD CA
93036-0617
US

IV. Provider business mailing address

2697 SAVIERS RD
OXNARD CA
93033-4519
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4200
  • Fax:
Mailing address:
  • Phone: 805-653-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: