Individual
JOSE MIGUEL BOLANOS RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
215 E HAWAII AVE # 140, NAMPA, ID 83686-6011
(208) 514-2529
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MRM-2246
ID
Other
Enumeration date
04/14/2023
Last updated
04/14/2023
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