Provider Demographics
NPI:1538400304
Name:BOYD, JAMIE (LAC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BOYD
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 1:4051 FORNEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4631
Mailing Address - Country:US
Mailing Address - Phone:619-894-4725
Mailing Address - Fax:
Practice Address - Street 1:3333 CAMINO DEL RIO S STE 320
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3837
Practice Address - Country:US
Practice Address - Phone:619-894-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11510171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist