Healthcare Provider Details

I. General information

NPI: 1073448288
Provider Name (Legal Business Name): ELEANOR BOLSTER SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELEANOR ZUBILLAGA

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MAIN AVE
DURANGO CO
81301-5157
US

IV. Provider business mailing address

3055 E 6TH AVE
DURANGO CO
81301-4353
US

V. Phone/Fax

Practice location:
  • Phone: 603-957-0099
  • Fax:
Mailing address:
  • Phone: 603-957-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWC.0000000869
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: