Provider Demographics
NPI:1083767180
Name:BOYD, LARISA (LAC)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11488
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-0488
Mailing Address - Country:US
Mailing Address - Phone:213-399-8469
Mailing Address - Fax:
Practice Address - Street 1:541 ATHOL AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1507
Practice Address - Country:US
Practice Address - Phone:213-399-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11425171100000X
CAAC 11425171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist