Individual
ANTONIA DE LA ISLA BOLANOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
5540 E LORENA AVE, FRESNO, CA 93727-6330
(559) 916-3104
Mailing address
5540 E LORENA AVE, FRESNO, CA 93727-6330
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
WV203250
CA
Other
Enumeration date
02/18/2019
Last updated
02/18/2019
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