Healthcare Provider Details

I. General information

NPI: 1255896478
Provider Name (Legal Business Name): AMANDA BONANO CARAMBOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TERRAZAS DE GUAYNABO J2 CALLE PASCUA
GUAYNABO PR
00969
US

IV. Provider business mailing address

TERRAZAS DE GUAYNABO J2 CALLE PASCUA
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-672-6463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number333635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: