Provider Demographics
NPI:1578052965
Name:BOSTON, CHERYL (LAC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BOSTON
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 1:151 N SUNRISE AVE STE 815
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2928
Mailing Address - Country:US
Mailing Address - Phone:916-723-9362
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE STE 815
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2928
Practice Address - Country:US
Practice Address - Phone:916-723-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16563171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty