Individual provider Active NPI

David Bolos

  • Hematology & Oncology Physician
  • Los Angeles, CA
National Provider Identifier
1134494321
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
A127574 Issued in CA
Practice address
757 Westwood PLZ
Suite 7501
Los Angeles, CA 90095-7417
Phone
(310) 825-7375
NPI assigned
Mar 20, 2012
Last updated
Dec 17, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Hematology & Oncology Physician 207RH0003X A127574 CA Primary

Addresses

Primary practice location

757 Westwood PLZ
Suite 7501
Los Angeles, CA 90095-7417

Mailing address

14445 Olive View Dr
Sylmar, CA 91342-1437
Phone (747) 210-3540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180319002524 CA Practitioner - Internal MedicinePractitioner - Hematology/Oncology 5698037281 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A127574CAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Mar 1, 2018 Accepting new patients
County of Los Angeles CurrentSince Mar 1, 2018 Accepting new patients

Locations

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1134494321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14445 OLIVE VIEW DR",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913421437",
            "telephone_number": "747-210-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 WESTWOOD PLZ",
            "address_2": "SUITE 7501",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900957417",
            "telephone_number": "310-825-7375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLOS",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-20",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A127574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.