Provider Demographics
NPI:1467584540
Name:BOLHOVITINOVA, VERONICA I (CA)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:I
Last Name:BOLHOVITINOVA
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BUCK RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1751
Mailing Address - Country:US
Mailing Address - Phone:215-322-7733
Mailing Address - Fax:215-322-7743
Practice Address - Street 1:82 BUCK RD UNIT A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-1751
Practice Address - Country:US
Practice Address - Phone:215-322-7733
Practice Address - Fax:215-322-7743
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000721171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist