Andrew William Bolan, RADT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1526620923 Issued in CA

Practice address

132 W 10TH St
San Pedro, CA 90731-3702

Phone

(310) 514-4940

NPI assigned

Apr 16, 2024

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

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.

• The Beacon House Association of San Pedro

  • Substance Abuse Rehabilitation Facility
  • San Pedro, CA
  • NPI 1386197267
  NPD (past)

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

{
    "created_epoch": "1713225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1285488106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 S BEACON ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907314324",
            "telephone_number": "310-514-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 W 10TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313702",
            "telephone_number": "310-514-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAN",
        "first_name": "ANDREW",
        "middle_name": "WILLIAM",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-16",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1526620923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Carolyn Ann Bojorquez, MA MFT
• Clara Bojorquez
• Bold Within Inc
• Justine Bonilla
• Stephanie Bonilla
• Teresa Bonilla, SUPPORT SPECIALIST
• Alison Booth, L.AC., DIPL. AC.

• Addiction (Substance Use Disorder) Counselor in San Pedro, CA
• Providers in San Pedro, 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 Apr 16, 2024; 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.