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General NPI Number Information
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NPI Number | 1245749688
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Entity Type | Organization
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Legal Business Name | BOLD HEALTH MEDICAL GROUP, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 561 SAXONY PL STE 101
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City | ENCINITAS
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State | CA
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Zip | 92024-7700
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Country | US
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Telephone | 760-503-5703
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Fax |
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Provider Business Mailing Address
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Address Line | 561 SAXONY PL STE 101
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City | ENCINITAS
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State | CA
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Zip | 92024-7700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | KATHRYN PAPIER HIRST
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Credential | MD
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Telephone | 760-503-4703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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