MEDICARE: DR. CASTRO JEAN MANIS BONNY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME150937	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760941751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASTRO JEAN MANIS BONNY MD

Provider Business Mailing Address
First Line	:	16555 NW 25TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6583
Country	:	US
Telephone Number	:	786-466-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	16555 NW 25TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6583
Country	:	US
Telephone Number	:	786-466-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	08/05/2022

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