Healthcare Provider Details

I. General information

NPI: 1801081955
Provider Name (Legal Business Name): RAMONA L. BOLOSAN LAC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 N BELLFLOWER BLVD SUITE 107
LONG BEACH CA
90815-4013
US

IV. Provider business mailing address

2408 HUNTINGTON LN APT #1
REDONDO BEACH CA
90278-4451
US

V. Phone/Fax

Practice location:
  • Phone: 562-999-4756
  • Fax:
Mailing address:
  • Phone: 808-778-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 17102
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU 1080
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMAT-8291
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: