Provider Demographics
NPI:1700198389
Name:BOLANOS, YEZMIN H (MD)
Entity Type:Individual
Prefix:
First Name:YEZMIN
Middle Name:H
Last Name:BOLANOS
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 1:3343 CALLE DONA JUANA
Mailing Address - Street 2:VISTA POINT
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-458-4838
Mailing Address - Fax:787-259-0991
Practice Address - Street 1:3348 CALLE DONA JUANA
Practice Address - Street 2:VISTA POINT
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4826
Practice Address - Country:US
Practice Address - Phone:787-458-4838
Practice Address - Fax:787-259-0991
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine