Nelson Jose Bolanos, PSYCHIATRIC TECH.

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

PT37969 Issued in CA

Practice address

2008 N Garey Ave
Pomona, CA 91767-2722

Phone

(909) 623-6131

Fax

(909) 865-9281

NPI assigned

Jun 5, 2019

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.

• Tri-City Mental Health Authority

  • Community/Behavioral Health Agency
  • Pomona, CA
  • NPI 1346304920
  NPD (past)
• Tri-City Mental Health Center

  • Case Management Agency
  • Pomona, CA
  • NPI 1255651501
  NPD (past)

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1376101212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131",
            "fax_number": "909-865-9281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131",
            "fax_number": "909-865-9281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANOS",
        "first_name": "NELSON",
        "middle_name": "JOSE",
        "credential": "PSYCHIATRIC TECH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "PT37969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tobias Konrad Boehm, D.D.S, PH.D.
• Alicia Sue Boggio, L.C.S.W.
• Danielle Boggs
• Sara Bokhari
• Elizabeth J Bolaji, CNM, NP-BC
• Stephen Bolen
• Sarah Boliek
• Bobbi Erin Bolz, RN
• Sarorn Bon
• Giana Bonaccorso

• Licensed Psychiatric Technician in Pomona, CA
• Providers in Pomona, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; 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.