Provider Demographics
NPI:1821623521
Name:BOLISAY, ERIC JAMES BAUTISTA (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIC JAMES
Middle Name:BAUTISTA
Last Name:BOLISAY
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:JAMES
Other - Last Name:BOLISAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3622 CLARINGTON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5095
Mailing Address - Country:US
Mailing Address - Phone:310-402-6367
Mailing Address - Fax:
Practice Address - Street 1:3622 CLARINGTON AVE APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5095
Practice Address - Country:US
Practice Address - Phone:310-402-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA745584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily