Provider Demographics
NPI:1689717076
Name:BOLDEN, BRIAN LORENZO
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LORENZO
Last Name:BOLDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4413
Mailing Address - Country:US
Mailing Address - Phone:707-268-2900
Mailing Address - Fax:
Practice Address - Street 1:904 G ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1829
Practice Address - Country:US
Practice Address - Phone:707-269-2001
Practice Address - Fax:707-269-2044
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374700000XNursing Service Related ProvidersTechnician