Healthcare Provider Details

I. General information

NPI: 1184696064
Provider Name (Legal Business Name): COMFORT BONU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR ST. VINCENT HOSPITALIST GROUP
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

455 SAINT MICHAELS DR PHYSICIAN PRACTICES
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-6130
  • Fax: 505-820-5408
Mailing address:
  • Phone: 505-989-6130
  • Fax: 505-820-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01049085A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2010-0050
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2010-0050
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2010-0050
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: