Healthcare Provider Details

I. General information

NPI: 1174930366
Provider Name (Legal Business Name): MR. JEAN W BONNY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2014
Last Update Date: 07/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15523 SW 171ST ST
MIAMI FL
33187-1378
US

IV. Provider business mailing address

15523 SW 171ST ST
MIAMI FL
33187-1378
US

V. Phone/Fax

Practice location:
  • Phone: 305-951-8953
  • Fax:
Mailing address:
  • Phone: 305-951-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: