Individual
MRS. LATOYA TRENISE BOLDS-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1350 CONNECTICUT AVE NW STE 1250, WASHINGTON, DC 20036-1728
(202) 627-1901
Mailing address
1 EMBARCADERO CTR STE 1900, SAN FRANCISCO, CA 94111-3723
(415) 658-6791
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C04725
MD
363A00000X
Physician Assistant
Primary
PA031955
DC
363A00000X
Physician Assistant
PA9481
MA
363AM0700X
Medical Physician Assistant
C04725
MD
363AM0700X
Medical Physician Assistant
PA08440
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C04725
MARYLAND PHYSICIAN ASSISTANT LICENSE
MD
01
—
PA08440
TEXAS MEDICAL BOARD PA LICENSE
TX
Enumeration date
05/26/2012
Last updated
11/10/2023
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