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Individual
JUAN JOSE BOLANOS
Active
Individual
JUAN JOSE BOLANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1488401122
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R1488401122
CREDENTIALS
CA
Enumeration date
12/28/2022
Last updated
05/11/2023
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