Provider Demographics
NPI:1578758512
Name:BOYD, GLORIA JEAN (BS)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:BOYD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3736
Mailing Address - Country:US
Mailing Address - Phone:619-229-8201
Mailing Address - Fax:
Practice Address - Street 1:5605 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3736
Practice Address - Country:US
Practice Address - Phone:619-229-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)