Provider Demographics
NPI:1437737137
Name:BOYOL, NICKOLAS JON
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:JON
Last Name:BOYOL
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 1:2646 UNICORNIO ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-5333
Mailing Address - Country:US
Mailing Address - Phone:760-815-8680
Mailing Address - Fax:
Practice Address - Street 1:6451 EL CAMINO REAL STE B2
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-2800
Practice Address - Country:US
Practice Address - Phone:858-755-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist