Provider Demographics
NPI:1043972003
Name:BOLANOS, ISIS
Entity Type:Individual
Prefix:MRS
First Name:ISIS
Middle Name:
Last Name:BOLANOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 CURTISS DR
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3014
Mailing Address - Country:US
Mailing Address - Phone:786-975-4784
Mailing Address - Fax:
Practice Address - Street 1:770 CURTISS DR
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3014
Practice Address - Country:US
Practice Address - Phone:786-975-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator