Provider Demographics
NPI:1306288253
Name:BOLOSAN, ALBERT L (PARAPROFESSIONAL)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:L
Last Name:BOLOSAN
Suffix:
Gender:M
Credentials:PARAPROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-269 KAHUAPILI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3521
Mailing Address - Country:US
Mailing Address - Phone:808-341-8087
Mailing Address - Fax:
Practice Address - Street 1:94-269 KAHUAPILI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3521
Practice Address - Country:US
Practice Address - Phone:808-341-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health