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General NPI Number Information
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NPI Number | 1669742714
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Entity Type | Organization
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Legal Business Name | B FIT PREVENTIVE CARE CLINIC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 1715 PACIFIC AVE N SUITE B
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City | LONG BEACH
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State | WA
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Zip | 98631-3604
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Country | US
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Telephone | 360-642-7246
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Fax | 360-642-3006
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Provider Business Mailing Address
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Address Line | PO BOX 1447
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City | LONG BEACH
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State | WA
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Zip | 98631-1447
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Country | US
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Telephone | 360-642-7246
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MR. DAVID ALLEN BOLEY II
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Credential | ARNP
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Telephone | 360-642-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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