Provider Demographics
NPI:1144429085
Name:BOLANTE, CHRISTINA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:BOLANTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SOUTH DR STE 115
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4211
Mailing Address - Country:US
Mailing Address - Phone:408-369-5600
Mailing Address - Fax:408-558-7949
Practice Address - Street 1:9781 BLUE LARKSPUR LN STE 100
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6509
Practice Address - Country:US
Practice Address - Phone:831-333-9008
Practice Address - Fax:831-333-9010
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133678207N00000X
WAMD60144269207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2832547Medicaid
MI0412675OtherBCBSM
MI0412675OtherBCBSM
WA1144429085Medicaid