MEDICARE: YEZMIN H BOLANOS M.D.

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
1	207R00000X	Internal Medicine Physician	20979	PR

General Provider Information

NPI Number	:	1700198389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEZMIN H BOLANOS M.D.

Provider Business Mailing Address
First Line	:	3343 CALLE DONA JUANA
Second Line	:	VISTA POINT
City	:	PONCE
State	:	PR
Zip	:	00716
Country	:	US
Telephone Number	:	787-458-4838
Fax Number	:	787-259-0991

Provider Business Practice Location Address
First Line	:	3348 CALLE DONA JUANA
Second Line	:	VISTA POINT
City	:	PONCE
State	:	PR
Zip	:	00716-4826
Country	:	US
Telephone Number	:	787-458-4838
Fax Number	:	787-259-0991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	08/29/2013

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