Healthcare Provider Details

I. General information

NPI: 1609788538
Provider Name (Legal Business Name): ERICA GARCIA-BOLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 POTRERO AVE BUILDING 90, 5TH FLOOR, RM 514
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

995 POTRERO AVE BUILDING 90, 5TH FLOOR, RM 514
SAN FRANCISCO CA
94110
US

V. Phone/Fax

Practice location:
  • Phone: 415-416-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: