Organization
SAMUEL A. BOLIVAR, MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA BOLIVAR (ADMINISTRATOR)
(909) 888-8154
Entity
Organization
Contact information
Practice address
555 N D ST, SUITE 130, SAN BERNARDINO, CA 92401-1305
(909) 888-8154
(909) 888-9940
Mailing address
3410 LA SIERRA AVE, F369, RIVERSIDE, CA 92503-5270
(909) 888-8154
(909) 888-9940
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A41590
CA
Other
Enumeration date
08/01/2014
Last updated
04/27/2023
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