Individual
BRENDA BOLANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
15 E KUU AKU LN UNIT 109, LAHAINA, HI 96761-2750
(310) 779-9680
Mailing address
PO BOX 356, LAHAINA, HI 96767-0356
(310) 779-9680
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
13382
HI
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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