Jackie A Bolds

Key facts

NPI

1356497101

Entity type

Individual (NPI type 1)

Primary specialty

Multi-Specialty Clinic/Center 261QM1300X

License

G57227 (CA)

Practice address

6066 Civic Terrace Ave
Newark, CA 94560

Phone

(510) 505-1600

Fax

(510) 494-7240

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356497101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10285",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "94610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6066 CIVIC TERRACE AVE",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "94560",
            "telephone_number": "510-505-1600",
            "fax_number": "510-494-7240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDS",
        "first_name": "JACKIE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "G57227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Newark, CA · Multi-Specialty Clinic/Center in California