1427288851 NPI number — BOLANOS ASSOCIATES, LLC.

Table of content: (NPI 1427288851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427288851 NPI number — BOLANOS ASSOCIATES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOLANOS ASSOCIATES, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427288851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15751 SHERIDAN ST # 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33331-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-259-0300
Provider Business Mailing Address Fax Number:
866-665-8671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 S UNIVERSITY DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33328-3835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-259-0300
Provider Business Practice Location Address Fax Number:
866-665-8671
Provider Enumeration Date:
07/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROCA
Authorized Official First Name:
JEANETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
786-259-0300

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  OT9463 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: OT9463 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)