Healthcare Provider Details

I. General information

NPI: 1831477306
Provider Name (Legal Business Name): BOLLINGER CANYON ANIMAL HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MONTGOMERY ST
SAN RAMON CA
94583-4777
US

IV. Provider business mailing address

400 MONTGOMERY ST
SAN RAMON CA
94583-4777
US

V. Phone/Fax

Practice location:
  • Phone: 925-866-8500
  • Fax: 877-821-9288
Mailing address:
  • Phone: 925-866-8500
  • Fax: 877-821-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberHSP6398
License Number StateCA

VIII. Authorized Official

Name: DR. SANDRA BLOCK
Title or Position: VETERINARIAN
Credential: DVM
Phone: 925-866-8500