Provider Demographics
NPI:1609421809
Name:BOLINDER, LARA
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:BOLINDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18400 KATY FWY
Mailing Address - Street 2:MOB1 500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094
Mailing Address - Country:US
Mailing Address - Phone:832-522-8400
Mailing Address - Fax:832-522-8401
Practice Address - Street 1:2440 N 11TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8102
Practice Address - Country:US
Practice Address - Phone:970-243-0900
Practice Address - Fax:970-245-4235
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical