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DR. JACKIE A BOLDS

Multi-Specialty >> Clinic/Center >> Ambulatory Health Care Facilities

Registrant NPI Number: 1356497101

Individual Registrant:
DR. JACKIE A BOLDS 
Gender: M
Sole Proprietor

Location and contact information for practice:
6066 CIVIC TERRACE AVE  NEWARK, CA 94560 US
Tel: 510-505-1600  Fax: 510-494-7240

Contact information for business:
PO BOX 10285  OAKLAND, CA 94610 US
Tel: --  Fax: --

Registration Information:
NPI: 1356497101
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QM1300XAmbulatory Health Care Facilities
Clinic/Center
Multi-Specialty
CAG57227

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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