Individual
DR. MARK M. BOISKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9834 GENESEE AVE, STE 312, LA JOLLA, CA 92037-1223
(858) 558-8150
(858) 346-1024
Mailing address
4225 EXECUTIVE SQ STE 450, LA JOLLA, CA 92037-8411
(858) 810-0000
(858) 268-1911
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A52055
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A520550
BLUE SHIELD OF CA
CA
05
—
00A520550
—
CA
01
—
AQ039X
NO. CALIFORNIA PTAN
CA
01
—
WA52055L
SO. CALIFORNIA PTAN
CA
Enumeration date
06/17/2005
Last updated
02/02/2021
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