Bolt Surgery Center, LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

BOLT SURGERY CENTER, LLC

Practice address

1124 S Main St Ste 102
Corona, CA 92882-4449

Phone

(928) 486-6004

NPI assigned

Jul 17, 2019

Organization subpart

No

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

Authorized official

Name

Kenna Morgan

Title

Nurse Manager

Phone

(928) 486-6004

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1649823964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 S MAIN ST STE 102",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928824449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 S MAIN ST STE 102",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928824449",
            "telephone_number": "928-486-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLT SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-17",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "KENNA",
        "authorized_official_title_or_position": "NURSE MANAGER",
        "authorized_official_telephone_number": "928-486-6004"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1013954130",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kenna@boltsurgerycenter.com",
            "affiliation": "N",
            "address_1": "1124 S Main St Ste 102",
            "city": "Corona",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928824449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patricia Ann Bogema, D.O.
• Dilma Carolina Bojorquez
• Yoneka Boleware
• Stefanie Marie Bolio
• Diane Marie Boll, PSY D
• Patrick Bonaparte, M.D.
• Katherine Eve Bonilla
• Ulises Bonola
• Tai Jonna Boone
• Page Borel

• Pain Medicine Physician in Corona, CA
• Providers in Corona, CA by specialty
• Pain Medicine Physician in California

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