Individual
KETSIA BOLIVAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
822 NE 125TH ST STE 109, NORTH MIAMI, FL 33161-5729
(954) 861-3761
Mailing address
4501 WOODLAND CIR, TAMARAC, FL 33319-3104
(305) 979-4281
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
—
—
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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