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General NPI Number Information
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NPI Number | 1962504456
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Entity Type | Individual
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Provider Name | RODRIGO A BOLANOS MD
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Gender | Male
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Dates
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Enumeration Date | 09/04/2006
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 200 AVENUE F NE STE 9118
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4131
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Country | US
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Telephone | 863-297-1777
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Fax | 863-297-1756
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Provider Business Mailing Address
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Address Line | 200 AVENUE F NE STE 9118
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4131
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Country | US
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Telephone | 863-292-4004
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Fax | 863-292-4005
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME121741
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License Number State | FL
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