Healthcare Provider Details

I. General information

NPI: 1477578698
Provider Name (Legal Business Name): ALVARO BOLIVAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 N F ST
SAN BERNARDINO CA
92410-3110
US

IV. Provider business mailing address

598 N F ST
SAN BERNARDINO CA
92410-3110
US

V. Phone/Fax

Practice location:
  • Phone: 909-888-8152
  • Fax: 909-884-7530
Mailing address:
  • Phone: 909-888-8152
  • Fax: 909-884-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA38312
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA38312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: