Healthcare Provider Details

I. General information

NPI: 1154075695
Provider Name (Legal Business Name): DR. CARLOS MANUEL BONET VAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CALLE GERARDO NIEVES MERCADO
COMERIO PR
00782-2540
US

IV. Provider business mailing address

PO BOX 421
COMERIO PR
00782-0421
US

V. Phone/Fax

Practice location:
  • Phone: 787-249-3767
  • Fax: 787-695-3535
Mailing address:
  • Phone: 787-249-3767
  • Fax: 787-695-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22903
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number22903
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: