Organization
ORTHONOW WESTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY BOLANOS (ADMINISTRATOR)
(954) 802-6763
Entity
Organization
Contact information
Practice address
4825 SW 148TH AVE, SOUTHWEST RANCHES, FL 33330-2129
(954) 802-6763
Mailing address
4825 SW 148TH AVE, SOUTHWEST RANCHES, FL 33330-2129
(954) 802-6763
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
HCC10353
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCCL 10353
HEATHCARE CLINIC LICENSE
FL
Enumeration date
10/03/2014
Last updated
10/03/2014
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