Healthcare Provider Details

I. General information

NPI: 1902878150
Provider Name (Legal Business Name): CYNTHIA BOYD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34730 BOB WILSON DR., SUITE 201
SAN DIEGO CA
92134
US

IV. Provider business mailing address

7219 FAY AVE
LA JOLLA CA
92037-5515
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-5715
  • Fax: 619-532-6070
Mailing address:
  • Phone: 858-459-6042
  • Fax: 858-459-4631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number19318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: