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General NPI Number Information
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NPI Number | 1578430773
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Entity Type | Individual
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Provider Name | RAMON BONIFACIO APN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 1 N STATE ST FL 15
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City | CHICAGO
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State | IL
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Zip | 60602-3206
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Country | US
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Telephone | 312-600-3991
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Fax | 630-473-2232
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Provider Business Mailing Address
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Address Line | 2918 W LOGAN BLVD UNIT 3E
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City | CHICAGO
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State | IL
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Zip | 60647-1732
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Country | US
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Telephone | 773-810-9120
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.033588
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License Number State | IL
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