Healthcare Provider Details

I. General information

NPI: 1184005365
Provider Name (Legal Business Name): GAIL BOLTRON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2015
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-5073
US

IV. Provider business mailing address

9003 PRINCETON WAY
BUENA PARK CA
90620-4639
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-7432
  • Fax: 520-694-6688
Mailing address:
  • Phone: 714-906-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDOS-1914
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2487
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: