Provider Demographics
NPI:1255106126
Name:BOLANOS, VICTOR ANTONIO
Entity type:Individual
Prefix:
First Name:VICTOR
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 1:1249 CALLE DON QUIJOTE
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2022
Mailing Address - Country:US
Mailing Address - Phone:787-637-2344
Mailing Address - Fax:
Practice Address - Street 1:1249 CALLE DON QUIJOTE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2022
Practice Address - Country:US
Practice Address - Phone:787-637-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program