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NPI Code Detail

MEDICARE: MRS. ADEPEJU BOLANLE GEORGE P.A.

MEDICARE: MRS. ADEPEJU BOLANLE GEORGE P.A.
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
1363AM0700XMedical Physician AssistantPA17876CA
2363A00000XPhysician AssistantPA17876CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316007685
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADEPEJU BOLANLE GEORGE P.A.
Provider Business Mailing Address
First Line : 9999 CORTINO WAY
Second Line :
City : ELK GROVE
State : CA
Zip : 95757-3052
Country : US
Telephone Number : 916-879-4157
Fax Number :
Provider Business Practice Location Address
First Line : 8233 E STOCKTON BLVD STE D
Second Line :
City : SACRAMENTO
State : CA
Zip : 95828-8203
Country : US
Telephone Number : 916-368-3080
Fax Number : 916-405-6551
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2006
Last Update Date : 11/16/2015

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