Healthcare Provider Details

I. General information

NPI: 1578936688
Provider Name (Legal Business Name): RACHEL BONZAGNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 WATERMAN ST
PROVIDENCE RI
02906-3109
US

IV. Provider business mailing address

163 WATERMAN ST
PROVIDENCE RI
02906-3109
US

V. Phone/Fax

Practice location:
  • Phone: 401-521-2580
  • Fax:
Mailing address:
  • Phone: 401-521-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAT00312
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: