Provider Demographics
NPI:1295907517
Name:DR. TAB A. BOYLE
Entity type:Organization
Organization Name:DR. TAB A. BOYLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-940-6350
Mailing Address - Street 1:44950 VALLEY CENTRAL WAY
Mailing Address - Street 2:#1-107
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7209
Mailing Address - Country:US
Mailing Address - Phone:661-940-6350
Mailing Address - Fax:661-942-3541
Practice Address - Street 1:44950 VALLEY CENTRAL WAY
Practice Address - Street 2:#1-107
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7209
Practice Address - Country:US
Practice Address - Phone:661-940-6350
Practice Address - Fax:661-942-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36862302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization