Provider Demographics
NPI:1801081955
Name:BOLOSAN, RAMONA L (LAC, LMT)
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:L
Last Name:BOLOSAN
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 HUNTINGTON LN
Mailing Address - Street 2:APT #1
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4451
Mailing Address - Country:US
Mailing Address - Phone:808-778-6776
Mailing Address - Fax:
Practice Address - Street 1:1777 N BELLFLOWER BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4013
Practice Address - Country:US
Practice Address - Phone:562-999-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-8291174400000X
CAAC 17102171100000X
HIACU 1080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171100000XOther Service ProvidersAcupuncturist