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Individual

MR. RYAN MABE BOLT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP-BC, FNP-C

Contact information

Practice address
10620 TREENA ST STE 230, SAN DIEGO, CA 92131-1140
(858) 609-9763
(504) 290-1145
Mailing address
10620 TREENA ST STE 230, SAN DIEGO, CA 92131-1140
(208) 850-6422

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
95008584
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95008584
CA

Other

Enumeration date
02/14/2018
Last updated
11/02/2023
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