Healthcare Provider Details

I. General information

NPI: 1023413069
Provider Name (Legal Business Name): MOLLY BUKOVEC ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22211 FOOTHILL BLVD
HAYWARD CA
94541-2712
US

IV. Provider business mailing address

22211 FOOTHILL BLVD
HAYWARD CA
94541-2712
US

V. Phone/Fax

Practice location:
  • Phone: 510-471-5907
  • Fax: 510-690-9065
Mailing address:
  • Phone: 510-471-5907
  • Fax: 510-690-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW32084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: