Basic Information
| Provider Information | |||||||||
| NPI: | 1750697736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CYNTHIA BOXRUD MD A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2021 SANTA MONICA BLVD | ||||||||
| Address2: | 700E | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108299060 | ||||||||
| FaxNumber: | 3108299015 | ||||||||
| Practice Location | |||||||||
| Address1: | 2021 SANTA MONICA BLVD | ||||||||
| Address2: | 700E | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108299060 | ||||||||
| FaxNumber: | 3108299015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2010 | ||||||||
| LastUpdateDate: | 04/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | BOXRUD | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3108299060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1100X | A50569 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Ophthalmic |
No ID Information.