Provider Demographics
NPI:1477659431
Name:CHIONG, VIOLETA BOLANOS (MD)
Entity Type:Individual
Prefix:
First Name:VIOLETA
Middle Name:BOLANOS
Last Name:CHIONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-392-7508
Mailing Address - Fax:561-392-7509
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:SUITE 340
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6465
Practice Address - Country:US
Practice Address - Phone:561-392-7508
Practice Address - Fax:561-392-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17670207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91334Medicare ID - Type Unspecified
FLD86472Medicare UPIN