Most Relevant Information
Provider Data
| NPI Number: | 1003570821 |
| Provider Name: | BOLIVAR PLACENCIA |
| Entity Type: | Individual |
| Taxonomy Code: | 332B00000X |
| Specialty: | Durable Medical Equipment & Medical Supplies |
| License Number: | 3150229 |
Most Important Dates
| Enumeration Date: | 10/27/2021 |
| Last Updated: | 11/04/2021 |
Provider Practice Location
588 RIDGEWOOD AVE
BROOKLYN
NY
112081834
Practice Location Phone/Fax
| Phone: | 6464070095 |
| Fax: |
Provider Mailing Location
588 RIDGEWOOD AVE
BROOKLYN
NY
112081834
Provider Mailing Phone/Fax
| Phone: | 6464070095 |
| Fax: |