=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801008917
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINE BOYD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 10/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1119 E STANLEY BLVD
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-454-3090
-----------------------------------------------------
Fax | 925-373-4055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1119 E STANLEY BLVD
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-454-3090
-----------------------------------------------------
Fax | 925-373-4055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTINE BOYD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 925-454-3090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080S0010X
-----------------------------------------------------
Taxonomy Name | Pediatric Sports Medicine Physician
-----------------------------------------------------
License Number | A73013
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------