Tanner Brock Boydstun

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1100 Sportfisher Drive
Oceanside, CA 92054

Phone

(760) 439-6702

Fax

(760) 439-4779

NPI assigned

Apr 21, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1518753045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SPORTFISHER DRIVE",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92054",
            "telephone_number": "760-439-6702",
            "fax_number": "760-439-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SPORTFISHER DRIVE",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92054",
            "telephone_number": "760-439-6702",
            "fax_number": "760-439-4779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYDSTUN",
        "first_name": "TANNER",
        "middle_name": "BROCK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-21",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Marie Bouk
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• Justin Bowles, M.D.
• Brianna Kim Bowman
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• Kristila Brace, M.A.
• Richard Jeffrey Brace, SUDRC
• Katie Mae E. Bradbury, BSW
• Bradford Eyecare Inc
• Bradford Optometry Corporation

• Addiction (Substance Use Disorder) Counselor in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.