Healthcare Provider Details

I. General information

NPI: 1346242005
Provider Name (Legal Business Name): DAVID ALFONSO BOLIVAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 POSADA LN STE C
TEMPLETON CA
93465-4054
US

IV. Provider business mailing address

292 POSADA LN STE C
TEMPLETON CA
93465-4054
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-3133
  • Fax: 805-434-3850
Mailing address:
  • Phone: 805-434-3133
  • Fax: 805-434-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA68461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: