Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G41069 | CA |
Y | 207NP0225X | Pediatric Dermatologist | G41069 | CA |
NPI | 1053488981 |
---|---|
Provider Name | Dr. Susan Boiko |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-2778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 28/01/2016 |