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General NPI Number Information
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NPI Number | 1215991534
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Entity Type | Organization
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Legal Business Name | BOLIVAR FAMILY MEDICAL CLINIC A MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 10327 HOLE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-1747
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Country | US
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Telephone | 951-351-1600
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Fax | 951-351-9400
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Provider Business Mailing Address
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Address Line | 10327 HOLE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-1747
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Country | US
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Telephone | 951-351-1600
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Fax | 951-351-9400
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. ALVARO BOLIVAR
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Credential | MD
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Telephone | 909-888-8152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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