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General NPI Number Information
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NPI Number | 1053008318
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Entity Type | Organization
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Legal Business Name | COMPASS NEPHROLOGY CARE, PLLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 2685 EXECUTIVE PARK DR STE 5
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City | WESTON
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State | FL
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Zip | 33331-3651
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Country | US
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Telephone | 954-590-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 2685 EXECUTIVE PARK DR STE 5
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City | WESTON
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State | FL
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Zip | 33331-3651
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Country | US
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Telephone | 954-590-0556
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | CHARLES AARON BONANNO
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Credential | MD
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Telephone | 954-590-0556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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