Healthcare Provider Details

I. General information

NPI: 1164400305
Provider Name (Legal Business Name): MAYRA Z BONNET ALVAREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAPANA MALLERY PLAZA STE 205
GUAYNABO PR
00966
US

IV. Provider business mailing address

690 CESAR GONZALEZ APT 1906, COND PARGUE DE LAS FUENTES
SAN JUAN PR
00918-3905
US

V. Phone/Fax

Practice location:
  • Phone: 787-782-0745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7861
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: