Healthcare Provider Details

I. General information

NPI: 1568487999
Provider Name (Legal Business Name): MARY K OBOYLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MAIL CODE 8759
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

200 W ARBOR DR MAIL CODE 8759
SAN DIEGO CA
92103-9001
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-2623
  • Fax: 619-543-3777
Mailing address:
  • Phone: 619-543-2623
  • Fax: 619-543-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG73501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: