Healthcare Provider Details

I. General information

NPI: 1922126374
Provider Name (Legal Business Name): JULIE L BOLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT ST 3RD FLOOR PHRS
PASADENA CA
91188-0001
US

IV. Provider business mailing address

393 E WALNUT ST 3RD FLOOR PHRS
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 626-405-7914
  • Fax:
Mailing address:
  • Phone: 626-405-7914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA90896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: