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NPI Code Detail

MEDICARE: VERONICA BOLOTNIKOVA

MEDICARE: VERONICA BOLOTNIKOVA
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1811213820
Entity Type Code : Individual
Provider Name (Legal Business Name) : VERONICA BOLOTNIKOVA
Provider Business Mailing Address
First Line : 225 N MARIPOSA AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-4509
Country : US
Telephone Number : 213-389-5820
Fax Number : 213-389-5802
Provider Business Practice Location Address
First Line : 225 N MARIPOSA AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-4509
Country : US
Telephone Number : 213-389-5820
Fax Number : 213-389-5802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2010
Last Update Date : 04/15/2010

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Directions to “ VERONICA BOLOTNIKOVA ” Practice Location

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