Bolsa Medical Group

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

A70808 Issued in CA

Legal business name

BOLSA MEDICAL GROUP

Practice address

10362 Bolsa Ave
Suite 110
Westminster, CA 92683-6763

Phone

(714) 531-2091

NPI assigned

May 2, 2013

Organization subpart

Yes

Parent organization

MEDVANTX, INC,As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Bolsa Medical Group Doing business as

Tax ID family

Bolsa Medical Group2 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bolsa Medical Group

  • Surgery Physician
  • Westminster, CA
  • NPI 1992732192
  NPD tax ID

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

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367452800000",
    "number": "1720423833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10362 BOLSA AVE",
            "address_2": "SUITE 110",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926836763",
            "telephone_number": "714-531-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLSA MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC,",
        "enumeration_date": "2013-05-02",
        "last_updated": "2013-05-02",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A70808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolsa Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bo Duong DDS Inc
• Barbara Bohnert
• Boi Bui Trinh & Tu Duc Pham PTR
• Bolsa Care Pharmacy Inc
• Bolsa Express Pharmacy, Inc.
• Bolsa Medical Group
• Bolsa Outpatient Surgery Center a Medical Corporation
• Bryce Caleb Bonilla-Haenn, LPCC
• Boyd J Joyer Jr DDS Inc
• Matthew Robert Brady, PSY.D.

• Non-Pharmacy Dispensing Site in Westminster, CA
• Providers in Westminster, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2013; 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.