Provider Demographics
NPI:1306138342
Name:BUONOMO, JESUS DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:DANIEL
Last Name:BUONOMO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11298
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1298
Mailing Address - Country:US
Mailing Address - Phone:787-692-3364
Mailing Address - Fax:787-705-8791
Practice Address - Street 1:CARR 1 KM 33.3 RALPH'S FOOD WAREHOUSE LOCAL # 3
Practice Address - Street 2:VIRO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-620-2100
Practice Address - Fax:787-421-7171
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0184402085N0904X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1457775959Medicaid