Provider Demographics
NPI:1902485675
Name:BOLO, VIRGIL L JR
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:L
Last Name:BOLO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 N RICE AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7270
Mailing Address - Country:US
Mailing Address - Phone:805-278-0612
Mailing Address - Fax:
Practice Address - Street 1:1889 N RICE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7270
Practice Address - Country:US
Practice Address - Phone:805-278-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician