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General NPI Number Information
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NPI Number | 1295784130
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Entity Type | Individual
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Provider Name | KELLY ELIZABETH BOYATT M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 31795 RANCHO CALIFORNIA RD STE B-700
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City | TEMECULA
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State | CA
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Zip | 92591-2993
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Country | US
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Telephone | 760-291-6700
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Fax | 951-294-9039
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Provider Business Mailing Address
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Address Line | 225 EAST SECOND AVENUE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4249
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Country | US
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Telephone | 760-291-6700
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Fax | 760-737-7324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A80960
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License Number State | CA
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