Provider Demographics
NPI:1902041593
Name:J. BRIAN BOYD, M.D., INC.
Entity Type:Organization
Organization Name:J. BRIAN BOYD, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:GLADYS
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-530-4200
Mailing Address - Street 1:22930 CRENSHAW BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3048
Mailing Address - Country:US
Mailing Address - Phone:310-530-4200
Mailing Address - Fax:310-530-1562
Practice Address - Street 1:22930 CRENSHAW BLVD STE D
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3048
Practice Address - Country:US
Practice Address - Phone:310-530-4200
Practice Address - Fax:310-530-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC51955Medicare PIN
CAF70322Medicare UPIN