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General NPI Number Information
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NPI Number | 1740139690
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Entity Type | Organization
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Legal Business Name | BOLANOS CONCIERGE MEDICINE LLC
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 12105 TAFT ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-1957
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Country | US
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Telephone | 754-232-1114
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Fax | 954-416-6283
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Provider Business Mailing Address
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Address Line | 12105 TAFT ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-1957
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Country | US
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Telephone | 754-232-1114
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Fax | 954-416-6283
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Authorized Official
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Title or Position | MANAGER
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Name | MR. ALAIN ALVAREZ LEGRA
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Credential |
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Telephone | 754-232-1114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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