Healthcare Provider Details

I. General information

NPI: 1962099226
Provider Name (Legal Business Name): T-ERICA BOYKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 WARING RD STE 4
SAN DIEGO CA
92120-2700
US

IV. Provider business mailing address

4950 WARING RD STE 4
SAN DIEGO CA
92120-2700
US

V. Phone/Fax

Practice location:
  • Phone: 619-663-6206
  • Fax:
Mailing address:
  • Phone: 619-663-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: