Individual
MS. ELLEN MAGDALENA BOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3600 BROADWAY, OAKLAND, CA 94611-5730
(201) 233-6718
Mailing address
77 GLEN AVE APT 105, OAKLAND, CA 94611-4955
(201) 233-6718
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60871
CA
Other
Enumeration date
05/05/2022
Last updated
06/21/2022
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