Provider Demographics
NPI:1366872889
Name:BOLIO, STEFANIE MARIE
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MARIE
Last Name:BOLIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:MARIE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1451 RIMPAU AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7522
Mailing Address - Country:US
Mailing Address - Phone:951-283-4756
Mailing Address - Fax:
Practice Address - Street 1:1451 RIMPAU AVE STE 212
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7522
Practice Address - Country:US
Practice Address - Phone:951-283-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96339106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist