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NPI Code Detail

MEDICARE: DR. JASON LEE BOLTON PSY.D.

MEDICARE: DR. JASON LEE BOLTON PSY.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
1103TC0700XClinical PsychologistPSY21293CA

General Provider Information

NPI Number : 1346373925
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON LEE BOLTON PSY.D.
Provider Business Mailing Address
First Line : 7056 BERTRAND AVE
Second Line :
City : RESEDA
State : CA
Zip : 91335-4710
Country : US
Telephone Number : 323-253-1668
Fax Number : 818-344-6290
Provider Business Practice Location Address
First Line : 15339 SATICOY ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91406-3345
Country : US
Telephone Number : 818-267-2623
Fax Number : 818-267-2665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/08/2007

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