Healthcare Provider Details

I. General information

NPI: 1841059730
Provider Name (Legal Business Name): RICARDO DANIEL BOLLINGER-VALLEJO AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICARDO DANIEL BOLLINGER-VALLEJO AUD

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 FORTUNES RIDGE DR STE A
DURHAM NC
27713-6102
US

IV. Provider business mailing address

5521 PARAMOUNT PARKWAY SUITE 420
MORRISVILLE NC
27560-5491
US

V. Phone/Fax

Practice location:
  • Phone: 919-419-1449
  • Fax:
Mailing address:
  • Phone: 984-974-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30004912
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: