Provider Demographics
NPI:1326234220
Name:BOYD, ALLISON LOUTANDA
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LOUTANDA
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LOUTANDA
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:8667 MARINERS DR
Mailing Address - Street 2:UNIT 64
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-4509
Mailing Address - Country:US
Mailing Address - Phone:209-351-4735
Mailing Address - Fax:
Practice Address - Street 1:445 W WEBER AVE
Practice Address - Street 2:SUITE 128C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-3151
Practice Address - Country:US
Practice Address - Phone:209-351-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA943612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered