=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073708558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOYKA DIMITROVA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2007
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1030 SIR FRANCIS DRAKE BLVD STE 120
-----------------------------------------------------
City | KENTFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94904-1439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-668-5955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1030 SIR FRANCIS DRAKE BLVD STE 120
-----------------------------------------------------
City | KENTFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94904-1439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-318-9066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY26932
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------