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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Mary Soso Bolela | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Mary | [sources] | |||
| Last name | Bolela | [sources] | |||
| Middle name | Soso | [sources] | |||
| NPI | 1871355578 | [sources] | |||
| Registration number | 95253681 | [sources] | |||
| Sector | Registered Nurse | [sources] | |||
| Address | 242 Holly Hill Drive, Jackson, MS, 39212 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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