Healthcare Provider Details

I. General information

NPI: 1427288851
Provider Name (Legal Business Name): BOLANOS ASSOCIATES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 72ND AVE STE 720
MIAMI FL
33126-1932
US

IV. Provider business mailing address

15751 SHERIDAN ST # 303
FORT LAUDERDALE FL
33331-3486
US

V. Phone/Fax

Practice location:
  • Phone: 786-259-0300
  • Fax: 866-665-8671
Mailing address:
  • Phone: 786-259-0300
  • Fax: 866-665-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberOT9463
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT9463
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEANETTE ROCA
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 786-259-0300