Healthcare Provider Details

I. General information

NPI: 1043885437
Provider Name (Legal Business Name): BOBBI ERIN BOLZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 06/15/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E ARROW HWY
POMONA CA
91767-2535
US

IV. Provider business mailing address

11371 TELEPHONE AVE
CHINO CA
91710-1818
US

V. Phone/Fax

Practice location:
  • Phone: 909-398-4383
  • Fax:
Mailing address:
  • Phone: 626-629-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95106291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: