Healthcare Provider Details

I. General information

NPI: 1366363855
Provider Name (Legal Business Name): JENNEAN MARIE BOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 ACARI AVE
SACRAMENTO CA
95835-1934
US

IV. Provider business mailing address

2575 AMELIA EARHART AVE
SACRAMENTO CA
95834-4004
US

V. Phone/Fax

Practice location:
  • Phone: 916-572-7276
  • Fax:
Mailing address:
  • Phone: 916-529-5510
  • Fax: 916-529-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: