Healthcare Provider Details

I. General information

NPI: 1023340924
Provider Name (Legal Business Name): CAROLINA V BONOMETTI CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR SUITE 102
MIAMI FL
33176-2144
US

IV. Provider business mailing address

8950 N KENDALL DR SUITE 102
MIAMI FL
33176-2144
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-8221
  • Fax: 305-273-0241
Mailing address:
  • Phone: 305-273-8221
  • Fax: 305-273-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number170105729085893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: