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Individual

DR. RODRIGO A BOLANOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
200 AVENUE F NE STE 9118, WINTER HAVEN, FL 33881-4131
(863) 297-1777
(863) 297-1756
Mailing address
200 AVENUE F NE STE 9118, WINTER HAVEN, FL 33881-4131
(863) 292-4004
(863) 292-4005

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME121741
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
013541400
FL
01
143NK
BC/BS NC PROVIDER #
01
1962504456
MEDCOST PROVIDER #
05
5909815
NC
01
N0022E
SOUTH CAROLINA MEDICAID
SC
01
P00665200
RAILROAD MEDICARE PROV#
Enumeration date
09/04/2006
Last updated
09/06/2024
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