Provider Demographics
NPI:1932309200
Name:BOLOMEY, TALITA CILA (DPT)
Entity Type:Individual
Prefix:
First Name:TALITA
Middle Name:CILA
Last Name:BOLOMEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 GROSSMONT CENTER DRIVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-315-0035
Mailing Address - Fax:619-315-0036
Practice Address - Street 1:5565 GROSSMONT CENTER DRIVE
Practice Address - Street 2:SUITE 360
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-315-0035
Practice Address - Fax:619-315-0036
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT33811BMedicare PIN
CAWPT33811AMedicare PIN