Provider Demographics
NPI:1962818807
Name:BOLANOS SALAZAR, CHRISTIAN G (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:G
Last Name:BOLANOS SALAZAR
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 1:62 BOYLSTON ST
Mailing Address - Street 2:APT 910
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4799
Mailing Address - Country:US
Mailing Address - Phone:617-369-2500
Mailing Address - Fax:
Practice Address - Street 1:6914 SHELDON RD STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2701
Practice Address - Country:US
Practice Address - Phone:813-910-0030
Practice Address - Fax:813-971-6473
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA260304207R00000X
CAA149943207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine