MEDICARE: JOSHUA FONSECA BOLANOS MD

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	207L00000X	Anesthesiology Physician	ME161030	FL
2	390200000X	Student in an Organized Health Care Education/Training Program	280081	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942860614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA FONSECA BOLANOS MD

Provider Business Mailing Address
First Line	:	1 SHIRCLIFF WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SHIRCLIFF WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4748
Country	:	US
Telephone Number	:	954-939-6636
Fax Number	:

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

Provider Enumeration Date	:	06/16/2019
Last Update Date	:	05/22/2026

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