Healthcare Provider Details

I. General information

NPI: 1053796037
Provider Name (Legal Business Name): DAMARIS JOHANNA BONET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BO LLANADAS
BARCELONETA PR
00617-2927
US

IV. Provider business mailing address

PO BOX 1182
BARCELONETA PR
00617-1182
US

V. Phone/Fax

Practice location:
  • Phone: 787-970-3542
  • Fax:
Mailing address:
  • Phone: 787-231-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number6809
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4574580
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerDRIVER LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: