Provider Demographics
NPI:1952838096
Name:BOLTHAUSEN, ESTHER LAZA
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:LAZA
Last Name:BOLTHAUSEN
Suffix:
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 1:6851 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-3416
Mailing Address - Country:US
Mailing Address - Phone:916-224-3148
Mailing Address - Fax:916-987-5780
Practice Address - Street 1:6851 BEECH AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-3416
Practice Address - Country:US
Practice Address - Phone:916-224-3148
Practice Address - Fax:916-987-5780
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility