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General NPI Number Information
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NPI Number | 1992721989
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Entity Type | Individual
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Provider Name | JOSE RAUL BOLANOS MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15899 LOS GATOS ALMADEN RD #4
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City | LOS GATOS
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State | CA
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Zip | 95032-3739
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Country | US
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Telephone | 408-358-8801
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Fax | 408-356-6781
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Provider Business Mailing Address
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Address Line | 15899 LOS GATOS ALMADEN RD #4
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City | LOS GATOS
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State | CA
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Zip | 95032-3739
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Country | US
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Telephone | 408-358-8801
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Fax | 408-356-6781
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G52463
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License Number State | CA
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