1679852420 NPI number — BENJAMIN SAMUEL BOYD P.T.

Table of content: BENJAMIN SAMUEL BOYD P.T. (NPI 1679852420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679852420 NPI number — BENJAMIN SAMUEL BOYD P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
BENJAMIN
Provider Middle Name:
SAMUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

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:
1679852420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 LITTLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94523-2178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-869-6511
Provider Business Mailing Address Fax Number:
510-869-6282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 POWELL ST
Provider Second Line Business Practice Location Address:
STE 6079
Provider Business Practice Location Address City Name:
EMERYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94608-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-593-7062
Provider Business Practice Location Address Fax Number:
510-336-2654
Provider Enumeration Date:
08/11/2011

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: 225100000X , with the licence number:  27777 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251G0304X , with the licence number: 27777 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 27777 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: FM306Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com