Healthcare Provider Details

I. General information

NPI: 1699833574
Provider Name (Legal Business Name): MRS. CARMELITA CHENG BOLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

IV. Provider business mailing address

1613 HUNTERS RUN
TUSCALOOSA AL
35405-6740
US

V. Phone/Fax

Practice location:
  • Phone: 205-750-5694
  • Fax:
Mailing address:
  • Phone: 205-366-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: