Provider Demographics
NPI:1588728422
Name:BOLAJI, ELIZABETH J (CNM, NP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:J
Last Name:BOLAJI
Suffix:
Gender:F
Credentials:CNM, NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14015 CHARLEMAGNE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-2331
Mailing Address - Country:US
Mailing Address - Phone:562-925-8252
Mailing Address - Fax:
Practice Address - Street 1:1177 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3028
Practice Address - Country:US
Practice Address - Phone:909-623-9900
Practice Address - Fax:909-623-1993
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP CERTIFICATE 15797363LF0000X
CANMW 1120367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily