Individual provider · NPI-1

Carydad Ann Bolivar

Specialist/Technologist, Athletic Trainer · Charlottesville, VA

NPI number1467145656
StatusActive
Last updated in NPPESJun 1, 2023

Details

NPI
1467145656
Entity type
Individual (NPI-1)
Name
Carydad Ann Bolivar
Sex
Female
Sole proprietor
Yes
Enumeration date
Jun 1, 2023
Certification date
May 25, 2023
Last updated
Jun 1, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer––Yes

Practice location

550 Brandon Ave
Charlottesville, VA 22903

Phone 786-443-4324

Mailing address

2394 Sw 19th St
Miami, FL 33145-2432

Phone 786-443-4324

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