Healthcare Provider Details

I. General information

NPI: 1831354620
Provider Name (Legal Business Name): DEER OAKS SOUTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 SAN PEDRO DR NE SUITE 222
ALBUQUERQUE NM
87110-6724
US

IV. Provider business mailing address

7272 WURZBACH RD SUITE 601
SAN ANTONIO TX
78240-4801
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-3505
  • Fax: 210-593-9863
Mailing address:
  • Phone: 210-615-3472
  • Fax: 210-593-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: PAUL ALAN BOSKIND
Title or Position: CEO
Credential: PH.D.
Phone: 210-615-3472