Individual
BRUCE A. BOLONESI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5131 COTTONWOOD ST # L-2, MURRAY, UT 84107-5701
(801) 263-3416
Mailing address
1121 E 3900 S, SUITE C-240, SALT LAKE CITY, UT 84124-1214
(801) 263-3416
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
106591-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
270286
ALTIUS
UT
Enumeration date
05/12/2006
Last updated
10/17/2011
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