Healthcare Provider Details

I. General information

NPI: 1750697736
Provider Name (Legal Business Name): CYNTHIA BOXRUD MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SANTA MONICA BLVD 700E
SANTA MONICA CA
90404-2208
US

IV. Provider business mailing address

2021 SANTA MONICA BLVD 700E
SANTA MONICA CA
90404-2208
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-9060
  • Fax: 310-829-9015
Mailing address:
  • Phone: 310-829-9060
  • Fax: 310-829-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberA50569
License Number StateCA

VIII. Authorized Official

Name: DR. CYNTHIA A. BOXRUD
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-829-9060