Basic Information
| Provider Information | |||||||||
| NPI: | 1700230745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYLE | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 255228 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958655228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004700071 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 W ESPLANADE AVE | ||||||||
| Address2: | SUITE 412 | ||||||||
| City: | KENNER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700652489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044642940 | ||||||||
| FaxNumber: | 0544642941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2016 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A19003 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 306548 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.