Vicente A Bolanos I

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA74686 Issued in FL

Practice address

501 NW 103Rd Ave
Pembroke Pines, FL 33026-3924

Phone

(954) 251-1497

Fax

(954) 404-9537

NPI assigned

Jan 15, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610668800000",
    "number": "1740879527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4791 SW 82ND AVE",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333283705",
            "telephone_number": "786-515-7162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 NW 103RD AVE",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263924",
            "telephone_number": "954-251-1497",
            "fax_number": "954-404-9537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLANOS",
        "first_name": "VICENTE",
        "middle_name": "A",
        "name_suffix": "I",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-15",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA74686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.caremax.com/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "501 NW 103rd Ave",
            "city": "Pembroke Pines",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330263924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nathan Boire, MD
• Bojana Bhardwaj MD PA
• Bolanos Clinical Research LLC
• Bolanos Concierge Medicine LLC
• Melody Bolanos, O.D.
• Yaolen Bolanos, MD
• Debra J. Bolger, LCSW
• Cristina Bolivar, APRN, FNP-C
• Byanca Bolivard, COTA/L
• Augustine A Bollo, DPM

• Massage Therapist in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.