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General NPI Number Information
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NPI Number | 1841217502
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Entity Type | Organization
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Legal Business Name | CARL THOMAS BOYLEN M.D. INC.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 274 1/2 S RAMPART BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-1404
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Country | US
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Telephone | 213-351-0030
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Fax | 213-388-3833
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Provider Business Mailing Address
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Address Line | 274 1/2 S RAMPART BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-1404
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Country | US
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Telephone | 213-351-0030
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Fax | 213-388-3833
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARL THOMAS BOYLEN
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Credential | M.D.
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Telephone | 213-351-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C30146
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License Number State | CA
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