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General NPI Number Information
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NPI Number | 1457715443
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Entity Type | Individual
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Provider Name | ADINA ALEXANDRA BODOLAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 6501 COYLE AVENUE
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City | CARMICHAEL
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State | CA
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Zip | 95608
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Country | US
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Telephone | 916-860-4460
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 340850
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City | SACRAMENTO
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State | CA
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Zip | 95834-0850
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Country | US
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Telephone | 916-860-4460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | A173236
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 042-0014689
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License Number State | VT
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