Basic Information
| Provider Information | |||||||||
| NPI: | 1942402045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLANOS | ||||||||
| FirstName: | YAOLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13876 NW 21ST ST | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330282619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544380632 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6540 NW 186TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330156004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058202033 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 10/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME104624 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.