ISSAC ISAIAH BOLANOS (NPI# 1407193840) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407193840 |
| Entity Type | Individual |
| Full Name | ISSAC ISAIAH BOLANOS |
| Credential | PA |
| Practice Address |
1313 Red River St Suite 200 Austin TX 78701-1943 |
| Practice Telephone | 5123911751 |
| Practice Fax Number | 5123911906 |
| Mailing Telephone | 5123911751 |
| Mailing Fax Number | 5123911906 |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2013-01-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA08063 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TX LICENSE | PA08063 | 01 |
| Street Address |
1313 RED RIVER ST SUITE 200 |
| City | AUSTIN |
| State | TX |
| Zip Code | 78701-1943 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164427936 | Debra Ann Lopez | Pharmacist | 1313 Red River St, Ste 100, Austin, TX 78701-1923 | 2005-06-16 |
| 1538695986 | Elizabeth Hamburg | Social Worker | 1313 Red River St, #100, Austin, TX 78701 | 2017-05-04 |
| 1952750291 | Julie Ayala | Obstetrics & Gynecology | 1313 Red River St, Suite A1, Austin, TX 78701-1943 | 2016-06-07 |
| 1467807610 | Michael Castellarin | Family Medicine | 1313 Red River St, Suite100, Austin, TX 78701-1943 | 2016-04-25 |
| 1023471158 | Kelly M. Dimattio | Obstetrics & Gynecology | 1313 Red River St, Suite A1, Austin, TX 78701-1943 | 2016-04-05 |
| 1740644806 | Shaila Patel | Obstetrics & Gynecology | 1313 Red River St, Suite A1, Austin, TX 78701-1943 | 2016-04-05 |
| 1114314622 | Casey Sehri Prammanasudh | Obstetrics & Gynecology | 1313 Red River St, Suite A1, Austin, TX 78701-1943 | 2015-04-22 |
| 1467857185 | Central Texas Community Health Centers | Clinic/Center | 1313 Red River St, Ste 100, Austin, TX 78701-1943 | 2014-10-23 |
| 1407266059 | Gwendolyn Luecke | Obstetrics & Gynecology | 1313 Red River St, Suite A1, Austin, TX 78701-1943 | 2014-05-05 |
| 1548670581 | Deborah A Lee | Obstetrics & Gynecology | 1313 Red River St, Suite A1, Austin, TX 78701-1943 | 2014-04-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710501820 | Megan Elise Gittins | Student in an Organized Health Care Education/Training Program | Ut Austin Dell Medical School 1400 Ih-35, Cec 300, Austin, TX 78701 | 2020-06-04 |
| 1306467956 | Jason Russell Paxman | Internal Medicine | Dell Seton Medical Center 1500 Red River, Austin, TX 78701 | 2020-05-05 |
| 1992326078 | Sarah N Ibanez Shaw | Emergency Medicine | Ut Austin Dell Medical School Em Residency Program, 1400 N. I-35, Suite 2.230, Austin, TX 78701 | 2020-04-30 |
| 1215558689 | Margaret Marie Coates | Student in an Organized Health Care Education/Training Program | 1400 N Interstate Highway 35, Cec 2.404, Austin, TX 78701 | 2020-04-27 |
| 1740817956 | Woody Starcloud Green | Emergency Medicine | Dell Emergency Medicine Residency Program, 1400 N. Interstate Hwy 35, Suite 2.230, Austin, TX 78701 | 2020-03-26 |
| 1235771403 | Central Ortho Assists Pllc | Physician Assistant | 501 Congress, Suite 150, Austin, TX 78701 | 2019-10-09 |
| 1114575792 | Shyneice Lasha Gaddis | Behavior Technician | 100 Congress Ave Suite 2000, Austin, TX 78701 | 2019-08-28 |
| 1245887355 | Jonathan Thomas Mason | Family Medicine | 1400 N-ih 35, Dell Seton Medical Center, Ste C2.410, Austin, TX 78701 | 2019-08-22 |
| 1538726195 | Zahra Virginia Cain-akbar | Student in an Organized Health Care Education/Training Program | Ut Dell Medical, 1500 Red River St, Austin, TX 78701 | 2019-05-20 |
| 1457918021 | Sara Lugonjic | Student in an Organized Health Care Education/Training Program | Ut Austin Dell Medical School Neurology Program, 1400 Ih- 35, Cec 300, Austin, TX 78701 | 2019-05-20 |
| Find all providers in zip 78701 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831704576 | Leila Olive Adell | Physician Assistant | 1221 S Congress Ave Apt 331, Austin, TX 78704-2461 | 2020-09-10 |
| 1740816982 | Alyssa Conrad | Physician Assistant | 4818 Star Jasmine Dr, Austin, TX 78723-6059 | 2020-03-19 |
| 1588207344 | Haley Margaret Roberts | Physician Assistant | 2200 Park Bend Dr Bldg 3-300, Austin, TX 78758-5386 | 2019-10-24 |
| 1073178901 | Ndukaku Dayton Ibe | Physician Assistant | 4411 Spicewood Springs Rd Apt 208, Austin, TX 78759-8570 | 2019-05-06 |
| 1285176172 | Leah Nichole Burandt | Physician Assistant | 2512 S Interstate 35 Ste 310, Austin, TX 78704 | 2016-11-09 |
| 1437607793 | Danielle Marie Werge | Physician Assistant | 6601 Vaught Ranch Rd, Suite 200, Austin, TX 78730-2307 | 2016-09-15 |
| 1831556158 | Kristin Serrano | Physician Assistant | 1524 S Interstate 35, Suite 202, Austin, TX 78704-8931 | 2016-01-16 |
| 1912309675 | Rachael Lichtenberger | Physician Assistant | 11609 Anderson Mill Rd, Austin, TX 78750-1354 | 2014-09-24 |
| 1417367707 | Sarah Caroline Moody Vance | Physician Assistant | 3000 N Interstate 35 Ste 600, Austin, TX 78705-1850 | 2014-05-07 |
| 1801165485 | Maegen Ricki Kennedy | Physician Assistant | 4107 South Captial Texas Hwy Suite 100a, Austin, TX 78704 | 2011-12-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.