Healthcare Provider Details

I. General information

NPI: 1548599525
Provider Name (Legal Business Name): BOLANOS SURGICAL SERVICES,C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO SUITE 723 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4728
US

IV. Provider business mailing address

1249 CALLE DON QUIJOTE COSTA CARIBE GOLF VILLA
PONCE PR
00716-2022
US

V. Phone/Fax

Practice location:
  • Phone: 787-290-4731
  • Fax: 787-259-3355
Mailing address:
  • Phone: 787-290-4731
  • Fax: 787-259-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GUILLERMO BOLANOS-AVILA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-290-4731