Juan Jose Bolanos

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1488401122 Issued in CA

Practice address

12960 San Pablo Ave
Richmond, CA 94805-1307

Phone

(510) 215-2280

Fax

(510) 215-2283

NPI assigned

Dec 28, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ujima Family Recovery Services

  • Substance Abuse Rehabilitation Facility
  • Richmond, CA
  • NPI 1881002541
  NPD (past)
• Ujma Family Recovery Services

  • Community/Behavioral Health Agency
  • Richmond, CA
  • NPI 1134240781
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1013620699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CHURCH LN",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063707",
            "telephone_number": "516-236-1004",
            "fax_number": "510-236-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12960 SAN PABLO AVE",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948051307",
            "telephone_number": "510-215-2280",
            "fax_number": "510-215-2283"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 Church Ln",
            "address_purpose": "LOCATION",
            "city": "San Pablo",
            "state": "CA",
            "postal_code": "948063707",
            "country_code": "US",
            "telephone_number": "516-236-1004",
            "fax_number": "510-236-3200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLANOS",
        "first_name": "JUAN",
        "middle_name": "JOSE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-28",
        "last_updated": "2023-05-11",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1488401122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CREDENTIALS",
            "identifier": "R1488401122",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paula Joan Boice
• Lorrie Suzanne Bojescu, PT
• Sharon S Bokarius-Snow, PSY.D.
• Vladimir Bokarius, M.D., PH.D., L.AC
• Gigi Saray Bolanos
• Jane Bonacich, MD
• Jacqueline Danielle Bonds
• Paula Bonnell
• Betaya Simone Boorda, PMHNP
• Scott Ellis Booth, SCHOOL PSYCHOLOGY

• Addiction (Substance Use Disorder) Counselor in Richmond, CA
• Providers in Richmond, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.