Provider Demographics
NPI:1194821561
Name:BOLESTA CENTER, INC.
Entity Type:Organization
Organization Name:BOLESTA CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOLMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-932-1184
Mailing Address - Street 1:7205 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4372
Mailing Address - Country:US
Mailing Address - Phone:813-932-1184
Mailing Address - Fax:813-932-9583
Practice Address - Street 1:7205 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4372
Practice Address - Country:US
Practice Address - Phone:813-932-1184
Practice Address - Fax:813-932-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty