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BOLIVAR FAMILY MEDICAL CLINIC A MEDICAL CORPORATION NPI 1215991534


NPI Information

NPI: 1215991534
Provider Name: BOLIVAR FAMILY MEDICAL CLINIC A MEDICAL CORPORATION
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 05D1021507

Address:
10327 HOLE AVE
RIVERSIDE, CA
ZIP 92505
Phone: (951) 351-1600
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BOLIVAR FAMILY MEDICAL CLINIC A MEDICAL CORPORATION is a specialist in Riverside, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. BOLIVAR FAMILY MEDICAL CLINIC A MEDICAL CORPORATION NPI is 1215991534. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

10327 HOLE AVE
RIVERSIDE, CA
ZIP 92505-747
Phone: (951) 351-1600
Fax: (951) 351-9400

The provider's authorized official is Alvaro Bolivar .
The authorized official title is Co-owner and has the following contact phone number (909) 888-8152.

The CLIA number assigned to this NPI record is 05D1021507 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/13/2006 and was last updated on 1/2/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1A88452MEDICARE UPINCALIFORNIA
200A532860MEDICAIDCALIFORNIA
3ZZZ19987ZMEDICARE PINCALIFORNIA
4R98617MEDICARE UPINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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