Provider Demographics
NPI:1215394135
Name:BOLEWARE, ASHLEY JENEA (MA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JENEA
Last Name:BOLEWARE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:JENEA
Other - Last Name:MALLORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1401 PARKMOOR AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3403
Mailing Address - Country:US
Mailing Address - Phone:408-971-9822
Mailing Address - Fax:
Practice Address - Street 1:1401 PARKMOOR AVE
Practice Address - Street 2:STE 230
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3403
Practice Address - Country:US
Practice Address - Phone:408-971-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47138OtherUNICARE