Individual
RAY BOLIVAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRT
Contact information
Practice address
CORNER OF BIA 12 AND BIA 7, FORT DEFIANCE, AZ 86504
(928) 129-3366
Mailing address
616 S HARDY DR UNIT 203, TEMPE, AZ 85281-7816
(928) 729-3366
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
Primary
312762
OR
Other
Enumeration date
12/23/2011
Last updated
12/23/2011
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