Provider Demographics
NPI:1467797712
Name:BOLIDO, LORRAINE GRACE (RN)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:GRACE
Last Name:BOLIDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W BROADWAY
Mailing Address - Street 2:APT. 318
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3879
Mailing Address - Country:US
Mailing Address - Phone:949-637-8812
Mailing Address - Fax:
Practice Address - Street 1:151 KALMUS DR STE K3
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5975
Practice Address - Country:US
Practice Address - Phone:714-384-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA823082171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator