Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | A165843 | CA |
NPI | 1164975330 |
---|---|
Provider Name | Dr. Felipe Bolivar Rincon |
First Address | Stockton, CA 95201-0779 |
Second Address | Stockton, CA 95210-3339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 08/07/2020 |