Healthcare Provider Details

I. General information

NPI: 1144429085
Provider Name (Legal Business Name): CHRISTINA MARIE BOLANTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9781 BLUE LARKSPUR LN STE 100
MONTEREY CA
93940-6509
US

IV. Provider business mailing address

525 SOUTH DR STE 115
MOUNTAIN VIEW CA
94040-4211
US

V. Phone/Fax

Practice location:
  • Phone: 831-333-9008
  • Fax: 831-333-9010
Mailing address:
  • Phone: 408-369-5600
  • Fax: 408-558-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA133678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: