Provider Demographics
NPI:1790709095
Name:BOLTON, STEPHANIE LAURALYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LAURALYNN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 BARTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1489
Mailing Address - Country:US
Mailing Address - Phone:909-558-9542
Mailing Address - Fax:
Practice Address - Street 1:1686 BARTON RD STE D
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-1489
Practice Address - Country:US
Practice Address - Phone:909-558-9542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA893462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry