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General NPI Number Information
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NPI Number | 1306138342
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Entity Type | Individual
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Provider Name | JESUS DANIEL BUONOMO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | CARR 1 KM 33.3 RALPH'S FOOD WAREHOUSE LOCAL # 3 VIRO
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-620-2100
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Fax | 787-421-7171
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Provider Business Mailing Address
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Address Line | PO BOX 11298
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City | SAN JUAN
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State | PR
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Zip | 00922-1298
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Country | US
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Telephone | 787-692-3364
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Fax | 787-705-8791
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | 018440
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 018440
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 018440
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License Number State | PR
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