Provider Demographics
NPI:1104573385
Name:BONAFONT, BIANCA VANESSA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:VANESSA
Last Name:BONAFONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SA47 PLAZA 2
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4845
Mailing Address - Country:US
Mailing Address - Phone:787-427-9752
Mailing Address - Fax:
Practice Address - Street 1:SA47 PLAZA 2
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4845
Practice Address - Country:US
Practice Address - Phone:787-427-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11045733851835P0018X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist