BOLSA MEDICAL GROUP NPI 1720423833

NPI Information

BOLSA MEDICAL GROUP is a non pharmacy dispensing site in Westminster, CA. The provider is a site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) BOLSA MEDICAL GROUP NPI is 1720423833. The provider is registered as an organization entity type.
The provider Is Doing Business As Bolsa Medical Group.

The provider's business location address is:

10362 BOLSA AVE
SUITE 110
WESTMINSTER, CA
ZIP 92683-763
Phone: (714) 531-2091

The provider's authorized official is Kenny Heine .
The authorized official title is Vp Of Operations and has the following contact phone number (858) 964-1506.

The CLIA number assigned to this NPI record is 05D0891062 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/2/2013 and was last updated on 5/2/2013.

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:

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