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General NPI Number Information
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NPI Number | 1366598500
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Entity Type | Individual
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Provider Name | CARLOS RANON BOLANO MD
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Gender | Male
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2925 W T C JESTER BLVD SUITE #1 (KIDS'NN TEENS CLINICS)
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City | HOUSTON
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State | TX
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Zip | 77018-7061
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Country | US
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Telephone | 713-681-7334
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Fax | 713-681-8520
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Provider Business Mailing Address
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Address Line | 15702 MISTY HEATH LN
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City | HOUSTON
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State | TX
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Zip | 77084-7550
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Country | US
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Telephone | 281-858-7650
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Fax | 281-858-5953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-3651
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License Number State | TX
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