Provider Demographics
NPI:1275039737
Name:BOLA, JASPREET KAUR (MS, MPH)
Entity Type:Individual
Prefix:
First Name:JASPREET
Middle Name:KAUR
Last Name:BOLA
Suffix:
Gender:F
Credentials:MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 LAVA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1841
Mailing Address - Country:US
Mailing Address - Phone:408-904-8102
Mailing Address - Fax:
Practice Address - Street 1:1172 MURPHY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2429
Practice Address - Country:US
Practice Address - Phone:408-728-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician