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NPI Code Detail

MEDICARE: MRS. ELIZABETH J BOLAJI CNM, NP-BC

MEDICARE:  MRS. ELIZABETH J BOLAJI  CNM, NP-BC
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
1363LF0000XFamily Nurse PractitionerNP CERTIFICATE 15797CA
2367A00000XAdvanced Practice MidwifeNMW 1120CA

General Provider Information

NPI Number : 1588728422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH J BOLAJI CNM, NP-BC
Provider Business Mailing Address
First Line : 14015 CHARLEMAGNE AVE
Second Line :
City : BELLFLOWER
State : CA
Zip : 90706-2331
Country : US
Telephone Number : 562-925-8252
Fax Number :
Provider Business Practice Location Address
First Line : 1177 N PARK AVE
Second Line :
City : POMONA
State : CA
Zip : 91768-3028
Country : US
Telephone Number : 909-623-9900
Fax Number : 909-623-1993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 10/18/2011

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Directions to “ MRS. ELIZABETH J BOLAJI CNM, NP-BC” Practice Location

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