Individual
JOAN SEBASTIAN BOLANOS LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5160 OCEAN HWY W, SHALLOTTE, NC 28470-4012
(910) 617-8325
Mailing address
PO BOX 5105, BELFAST, ME 04915-5100
(919) 220-5255
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-15626
NC
Other
Enumeration date
04/22/2025
Last updated
08/08/2025
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