Provider Demographics
NPI:1548599525
Name:BOLANOS SURGICAL SERVICES,C.S.P.
Entity Type:Organization
Organization Name:BOLANOS SURGICAL SERVICES,C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLANOS-AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-290-4731
Mailing Address - Street 1:1249 CALLE DON QUIJOTE
Mailing Address - Street 2:COSTA CARIBE GOLF VILLA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2022
Mailing Address - Country:US
Mailing Address - Phone:787-290-4731
Mailing Address - Fax:787-259-3355
Practice Address - Street 1:909 AVE TITO CASTRO
Practice Address - Street 2:SUITE 723 TORRE MEDICA SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-290-4731
Practice Address - Fax:787-259-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty