Healthcare Provider Details

I. General information

NPI: 1972744878
Provider Name (Legal Business Name): DARYA REBECCA BOLAND N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 12/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 PINE ST
PASO ROBLES CA
93446-2520
US

IV. Provider business mailing address

1020 PINE ST
PASO ROBLES CA
93446-2520
US

V. Phone/Fax

Practice location:
  • Phone: 805-226-5190
  • Fax: 805-226-5191
Mailing address:
  • Phone: 805-226-5190
  • Fax: 805-226-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: