1548833767 NPI number — JYOTPREET KAUR BOYE

Table of content: JYOTPREET KAUR BOYE (NPI 1548833767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548833767 NPI number — JYOTPREET KAUR BOYE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYE
Provider First Name:
JYOTPREET
Provider Middle Name:
KAUR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548833767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
426 CALLE CONVERSE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010-1838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-824-9197
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18107 SHERMAN WAY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91335-4564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-783-0072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2021

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: 363LF0000X , with the licence number:  95017724 , 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)