Provider Demographics
NPI:1649454364
Name:BOLLING, LETITIA (RN)
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:
Last Name:BOLLING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2403
Mailing Address - Country:US
Mailing Address - Phone:510-577-7087
Mailing Address - Fax:510-577-7078
Practice Address - Street 1:7200 BANCROFT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-577-7087
Practice Address - Fax:510-577-7078
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365963163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management