Provider Demographics
NPI:1982028742
Name:BOYER GRIFFIN, TARYN MARIE
Entity Type:Individual
Prefix:MRS
First Name:TARYN
Middle Name:MARIE
Last Name:BOYER GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:MARIE
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 CALLE AMANECER STE 320
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-4222
Mailing Address - Country:US
Mailing Address - Phone:808-637-4370
Mailing Address - Fax:
Practice Address - Street 1:901 CALLE AMANECER STE 320
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-4222
Practice Address - Country:US
Practice Address - Phone:808-637-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13634225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60468Medicaid