Matthew Edward Bolerjack

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

104470 Issued in CA

Practice address

7130 Miramar Rd Ste 400
San Diego, CA 92121-2340

Phone

(619) 609-3171

NPI assigned

Apr 15, 2022

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

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649980800000",
    "number": "1740923937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6879 OROLA LN",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919424525",
            "telephone_number": "619-609-3171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7130 MIRAMAR RD STE 400",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212340",
            "telephone_number": "619-609-3171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLERJACK",
        "first_name": "MATTHEW",
        "middle_name": "EDWARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "CA",
            "license": "104470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenna Kailyn Boldt
• Ryan William Bolduc
• Christina Rose Bolen
• April Lyn Bolenbaugh, M.ED
• Alexander James Bolender
• Callie Elizabeth Boles
• Kody Ryan Boles, PT, DPT
• Scott M Boles, MD
• Leslie Boley
• Tami Bolf-Schmidt, NP

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; 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.