Provider Demographics
NPI:1942591011
Name:BOLSTER, CHARMEL X
Entity Type:Individual
Prefix:MISS
First Name:CHARMEL
Middle Name:
Last Name:BOLSTER
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 S STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4933
Mailing Address - Country:US
Mailing Address - Phone:951-791-3550
Mailing Address - Fax:951-791-3397
Practice Address - Street 1:1370 S STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4933
Practice Address - Country:US
Practice Address - Phone:951-791-3550
Practice Address - Fax:951-791-3397
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health