Provider Demographics
NPI:1629371612
Name:BOLANOS, ROLANDO ANTONIO
Entity Type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:ANTONIO
Last Name:BOLANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 S JONES BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5606
Mailing Address - Country:US
Mailing Address - Phone:702-682-9867
Mailing Address - Fax:
Practice Address - Street 1:2965 S JONES BLVD STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5606
Practice Address - Country:US
Practice Address - Phone:702-682-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker