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General NPI Number Information
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NPI Number | 1942402045
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Entity Type | Individual
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Provider Name | YAOLEN BOLANOS MD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 04/14/2025
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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 | 13876 NW 21ST ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2619
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Country | US
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Telephone | 954-579-0587
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME104624
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License Number State | FL
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