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NPI Code Detail

MEDICARE: MISS CHARMEL BOLSTER X

MEDICARE: MISS CHARMEL BOLSTER X
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1942591011
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS CHARMEL BOLSTER X
Provider Business Mailing Address
First Line : 1370 S STATE ST
Second Line : SUITE B
City : SAN JACINTO
State : CA
Zip : 92583-4933
Country : US
Telephone Number : 951-791-3550
Fax Number : 951-791-3397
Provider Business Practice Location Address
First Line : 1370 S STATE ST
Second Line : SUITE B
City : SAN JACINTO
State : CA
Zip : 92583-4933
Country : US
Telephone Number : 951-791-3550
Fax Number : 951-791-3397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2011
Last Update Date : 04/25/2011

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Directions to “ MISS CHARMEL BOLSTER X ” Practice Location

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