Provider Demographics
NPI:1366598500
Name:BOLANO, CARLOS RANON (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RANON
Last Name:BOLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15702 MISTY HEATH LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7550
Mailing Address - Country:US
Mailing Address - Phone:281-858-7650
Mailing Address - Fax:281-858-5953
Practice Address - Street 1:2925 W T C JESTER BLVD
Practice Address - Street 2:SUITE #1 (KIDS'NN TEENS CLINICS)
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-7061
Practice Address - Country:US
Practice Address - Phone:713-681-7334
Practice Address - Fax:713-681-8520
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-3651208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics