MEDICARE: MARIE TITA DAYOLA BOLO

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	374U00000X	Home Health Aide		CA

General Provider Information

NPI Number	:	1518820372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE TITA DAYOLA BOLO

Provider Business Mailing Address
First Line	:	44989 CHECKERBLOOM DR
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-4168
Country	:	US
Telephone Number	:	951-206-4311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 1/2 EAST BRADLEY AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021
Country	:	US
Telephone Number	:	951-206-4311
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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