Provider Demographics
NPI:1437128824
Name:BOLADO, ASBEL OBED (PA)
Entity Type:Individual
Prefix:MR
First Name:ASBEL
Middle Name:OBED
Last Name:BOLADO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 BAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7307
Mailing Address - Country:US
Mailing Address - Phone:559-686-5512
Mailing Address - Fax:
Practice Address - Street 1:16928 11TH STREET
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:CA
Practice Address - Zip Code:93234
Practice Address - Country:US
Practice Address - Phone:559-945-2541
Practice Address - Fax:559-645-1107
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 18029363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant