Healthcare Provider Details

I. General information

NPI: 1750084737
Provider Name (Legal Business Name): CODY MORGAN BOYER-SPROUSE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CODY MORGAN SPROUSE DO

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 619-532-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A23472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: