Individual ProviderJose Raul BolanosObstetrics & GynecologyAllopathic & Osteopathic PhysiciansPractice Address15899 Los Gatos Almaden Rd #4, Los Gatos, CA 95032-3739(408) 358-8801PECOS EnrollmentBased on the most recent information from CMS, provider Jose Raul Bolanos does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:51 AM.Profile DetailsProvider ID1992721989Provider TypeIndividualFull NameBolanos, Jose RaulCredentialMDGenderMaleSole ProprietorNoEnumeration Date7/14/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address15899 Los Gatos Almaden Rd #4, Los Gatos, CA 95032-3739Phone(408) 358-8801Fax(408) 356-6781Mailing LocationMailing Address15899 Los Gatos Almaden Rd #4, Los Gatos, CA 95032-3739Phone(408) 358-8801Fax(408) 356-6781Provider TaxonomiesCodeDescriptionLicenseCode207V00000XPrimaryDescriptionObstetrics & GynecologyAllopathic & Osteopathic PhysiciansLicenseG52463CaliforniaProvider IdentifiersIDDescriptionIssuerID00G524630DescriptionMedicaidIssuerUnlistedCalifornia