Provider Demographics
NPI:1316098783
Name:BIOLLO, AMERIGO J
Entity type:Individual
Prefix:DR
First Name:AMERIGO
Middle Name:J
Last Name:BIOLLO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:AMERIGO
Other - Middle Name:J
Other - Last Name:BIOLLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:712 D ST
Mailing Address - Street 2:STE J
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3709
Mailing Address - Country:US
Mailing Address - Phone:415-457-9600
Mailing Address - Fax:415-457-1222
Practice Address - Street 1:712 D ST
Practice Address - Street 2:STE J
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3709
Practice Address - Country:US
Practice Address - Phone:415-457-9600
Practice Address - Fax:415-457-1222
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor