Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | A24200 | CA |
NPI | 1013091677 |
---|---|
Provider Name | Dr. M Michael Boldy |
First Address | Hemet, CA 92543-4424 |
Second Address | Hemet, CA 92543-4424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A242000 | (05) | CA |
A82960 | (02) | CA |