Provider Demographics
NPI:1235701616
Name:BOYERMAN, GENARO
Entity Type:Individual
Prefix:
First Name:GENARO
Middle Name:
Last Name:BOYERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7953 WISNER AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5621
Mailing Address - Country:US
Mailing Address - Phone:818-522-2618
Mailing Address - Fax:
Practice Address - Street 1:5554 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2200
Practice Address - Country:US
Practice Address - Phone:800-683-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician