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NPI Code Detail

MEDICARE: CHEYENNE BOLANOS

MEDICARE: CHEYENNE BOLANOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCA
2163W00000XRegistered Nurse95351539CA

General Provider Information

NPI Number : 1528910825
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHEYENNE BOLANOS
Provider Business Mailing Address
First Line : 1891 EFFIE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1793
Country : US
Telephone Number : 323-644-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1891 EFFIE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1793
Country : US
Telephone Number : 323-644-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2026
Last Update Date : 02/16/2026

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Directions to “ CHEYENNE BOLANOS ” Practice Location

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