Individual
NELSON JOSE BOLANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHIATRIC TECH.
Contact information
Practice address
2008 N GAREY AVE, POMONA, CA 91767-2722
(909) 623-6131
(909) 865-9281
Mailing address
2008 N GAREY AVE, POMONA, CA 91767-2722
(909) 623-6131
(909) 865-9281
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT37969
CA
Other
Enumeration date
06/05/2019
Last updated
06/17/2019
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