Provider Demographics
NPI:1285331793
Name:BAMBOLINAS
Entity type:Organization
Organization Name:BAMBOLINAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:DEL BIAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:916-613-8867
Mailing Address - Street 1:149 IRON POINT RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-9000
Mailing Address - Country:US
Mailing Address - Phone:916-581-6272
Mailing Address - Fax:916-461-9734
Practice Address - Street 1:149 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9000
Practice Address - Country:US
Practice Address - Phone:916-581-6272
Practice Address - Fax:916-461-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment