Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 94024879 | CA |
Y | 103T00000X | Psychologist | 94024879 | CA |
NPI | 1003420142 |
---|---|
Provider Name | Dr. Odette Boyd |
First Address | Rancho Cucamonga, CA 91730-3889 |
Second Address | Anaheim, CA 92807-2056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2020 |
Last Update Date | 05/09/2020 |