Healthcare Provider Details

I. General information

NPI: 1992170773
Provider Name (Legal Business Name): BONNIE GALVEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

PO BOX 12493
MIAMI FL
33101-2493
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6913
  • Fax: 305-585-0000
Mailing address:
  • Phone: 305-585-4249
  • Fax: 305-355-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9278837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: