MEDICARE: DR. TODD FRANKLIN BOLINGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	G79612	CA

General Provider Information

NPI Number	:	1265567606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD FRANKLIN BOLINGER M.D.

Provider Business Mailing Address
First Line	:	3711 LONG BEACH BLVD
Second Line	:	SUITE 600
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 LONG BEACH BLVD
Second Line	:	SUITE 600
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3315
Country	:	US
Telephone Number	:	562-485-3075
Fax Number	:	562-981-7569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	11/06/2021

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