1871859421 NPI number — MISS LISA NAKHLEH BOYD P.A.

Table of content: MISS LISA NAKHLEH BOYD P.A. (NPI 1871859421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871859421 NPI number — MISS LISA NAKHLEH BOYD P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
LISA
Provider Middle Name:
NAKHLEH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAKHLEH
Provider Other First Name:
LISA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871859421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W ARBOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-926-8273
Provider Business Mailing Address Fax Number:
888-539-8781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2999 HEALTH CENTER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-939-4480
Provider Business Practice Location Address Fax Number:
858-939-4452
Provider Enumeration Date:
04/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA20326 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)