Bolsa Medical MTM Pharma Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BOLSA MEDICAL MTM PHARMA INC

Practice address

6552 Bolsa Ave Ste a
Huntington Beach, CA 92647-2656

Phone

(714) 916-5383

Fax

(714) 916-5384

NPI assigned

May 3, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Tina Tuyet Quach-TranNPI 1124658471

Title

President / Pharmacist in Charge

Phone

(714) 916-5383

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• MTM PHARMACY IV Doing business as

Medicare fee-for-service enrollment

Enrolled in CA3 enrollments

Enrollment records 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tina Tuyet Quach-Tran

  • Pharmacist
  • Huntington Beach, CA
  • NPI 1124658471
  NPD Authorized official
• Dong Nghi Hai Lam

  • Pharmacist
  • Huntington Beach, CA
  • NPI 1578170478
  NPD
• Tu Nguyen, MD

  • Internal Medicine Physician
  • Westminster, CA
  • NPI 1740217942
  NPD (past)

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1306372891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6552 BOLSA AVE",
            "address_2": "STE A",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926472660",
            "telephone_number": "714-916-5383",
            "fax_number": "714-916-5384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6552 BOLSA AVE STE A",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926472656",
            "telephone_number": "714-916-5383",
            "fax_number": "714-916-5384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLSA MEDICAL MTM PHARMA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-03",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "QUACH-TRAN",
        "authorized_official_first_name": "TINA TUYET",
        "authorized_official_title_or_position": "PRESIDENT / PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "714-916-5383",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3622641",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "PHY57954",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MTM PHARMACY IV",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Austin Dean Boelman, MSW
• Barbara Ellen Bogorad, PSYD.
• Debra Lynn Bolla, DDS
• Julie Bolton, D.O.
• Sarah Bond-Murcia, R.D.
• Gabriel Magat Bonifacio, PT, DPT, CSCS
• Mark Gerald M Bonifacio, NP
• Christopher M Bonin, DDS

• Community/Retail Pharmacy in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.