Healthcare Provider Details

I. General information

NPI: 1366744682
Provider Name (Legal Business Name): AMANDA L. BOYD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA ST
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

333 N SANTA ROSA ST
SAN ANTONIO TX
78207-3108
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-4275
  • Fax:
Mailing address:
  • Phone: 210-704-4275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003342
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: