Provider Demographics
NPI:1902198864
Name:BOLASINI, ALFREDO (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:BOLASINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 N HILLS DR
Mailing Address - Street 2:SUITE 32
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2464
Mailing Address - Country:US
Mailing Address - Phone:954-456-6336
Mailing Address - Fax:
Practice Address - Street 1:4040 N HILLS DR
Practice Address - Street 2:SUITE 32
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2464
Practice Address - Country:US
Practice Address - Phone:954-456-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME314502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry