Doctor Name: | THERESA LYNN BOLOGNA |
NPI Number: | 1003148339 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 369409 |
Business Practice Address: | 1701 Mission Ave Suite A Oceanside, CA - 920587102 |
Business Phone Number: | 7609674475 |
Business Fax Number: | 7609663827 |
Mailing Address: | 1701 Mission Ave, Suite A OCEANSIDE |
State: | CA |
Postal Code: | 920587102 |
Phone Number: | 7609674475 |
Fax Number: | 7609663827 |
NPI Enumeration Date: | 02/11/2010 |
NPI Last Update Date: | 02/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WC0400X |
License Number: | 369409 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Case Management |
Taxonomy Definition: |