Provider Demographics
NPI:1174553259
Name:BOSTON, LAURA HEYING (MSN, CNM, NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:HEYING
Last Name:BOSTON
Suffix:
Gender:F
Credentials:MSN, CNM, NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:HEYING
Other - Last Name:GOOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2323
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:251 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2628
Practice Address - Country:US
Practice Address - Phone:619-515-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376078163WP2201X
CA5946363LX0001X
CANMF792367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology