Provider Demographics
NPI:1750438511
Name:BOYD & GARCIA MEDICAL GROUP
Entity type:Organization
Organization Name:BOYD & GARCIA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:FRANCINE
Authorized Official - Last Name:RAMIREZ-BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-633-4463
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4223
Mailing Address - Country:US
Mailing Address - Phone:714-547-8700
Mailing Address - Fax:
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4223
Practice Address - Country:US
Practice Address - Phone:714-547-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59399261QM2500X
CAG71922261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G719220Medicaid
CA00G719223Medicaid
CAG71922OtherDR GARCIA'S LICENSE
CAGR0087980Medicaid
CA00G593990Medicaid
CA00G593991Medicaid
CAG59399OtherDR BOYD'S LICENSE
CA00G593991Medicaid
CAW14962Medicare ID - Type UnspecifiedDR BOYD'S INDIVIDUAL
CA00G593990Medicaid
CAG59399OtherDR BOYD'S LICENSE
CAWG5959399DMedicare ID - Type UnspecifiedMEDICARE GROUP #