Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1063601656 |
---|---|
Provider Name | Dolores Bolton |
First Address | Santa Cruz, CA 95062-2239 |
Second Address | Santa Cruz, CA 95062-2239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2007 |
Last Update Date | 18/10/2007 |