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General NPI Number Information
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NPI Number | 1922246610
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Entity Type | Organization
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Legal Business Name | BOLANOS-MCMAHAN, LLC.
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 401 E LAS OLAS BLVD STE 130-451
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2210
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Country | US
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Telephone | 561-891-9148
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Fax | 954-607-5852
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Provider Business Mailing Address
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Address Line | 401 E LAS OLAS BLVD STE 130-451
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2210
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Country | US
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Telephone | 561-891-9148
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Fax | 954-607-5852
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Authorized Official
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Title or Position | MGRM
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Name | JENNIFER LYNN MCMAHAN
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Credential | OTR/L
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Telephone | 561-891-9148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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