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General NPI Number Information
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NPI Number | 1659261758
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Entity Type | Individual
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Provider Name | TOM BOLGER
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Gender | Male
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 2152 CAMINITO CIRCULO SUR
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City | LA JOLLA
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State | CA
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Zip | 92037-7216
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Country | US
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Telephone | 970-270-8225
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Fax |
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Provider Business Mailing Address
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Address Line | 2152 CAMINITO CIRCULO SUR
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City | LA JOLLA
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State | CA
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Zip | 92037-7216
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Country | US
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Telephone | 970-270-8225
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 20A5441
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License Number State | CA
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