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BOLD HEALTH MEDICAL GROUP A PROFESSIONAL CORPORATION NPI 1245749688


NPI Information

NPI: 1245749688
Provider Name: BOLD HEALTH MEDICAL GROUP, A PROFESSIONAL CORPORATION

Doing Business As: BOLD HEALTH MEDICAL GROUP

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

CLIA Number: 05D2137485

Address:
561 SAXONY PL STE 101
ENCINITAS, CA
ZIP 92024
Phone: (760) 503-5703
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BOLD HEALTH MEDICAL GROUP, A PROFESSIONAL CORPORATION is a mental health (including community mental health center) clinic center in Encinitas, CA. BOLD HEALTH MEDICAL GROUP, A PROFESSIONAL CORPORATION NPI is 1245749688. The provider is registered as an organization entity type.
The provider Is Doing Business As Bold Health Medical Group.

The provider's business location address is:

561 SAXONY PL STE 101
ENCINITAS, CA
ZIP 92024-700
Phone: (760) 503-5703

The provider's authorized official is Kathryn Papier Hirst .
The authorized official title is Chief Medical Officer and has the following contact phone number (760) 503-4703.

The CLIA number assigned to this NPI record is 05D2137485 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/28/2017 and was last updated on 10/13/2022.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM1300XClinic/CenterMulti-SpecialtyNo
2261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
3261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)Yes

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: 5/5/2024

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