Healthcare Provider Details

I. General information

NPI: 1811105315
Provider Name (Legal Business Name): ANTONIO FARIA-BONANO M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CALLE CERRA CDT GUALBERTO RABELL
SAN JUAN PR
00907-5104
US

IV. Provider business mailing address

20 CALLE FLAMINGO
ARECIBO PR
00612-9532
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-1360
  • Fax: 787-723-6247
Mailing address:
  • Phone: 787-650-6883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: