Provider Demographics
NPI:1487311288
Name:BORONICO, DANIEL (HEALTH EDUC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BORONICO
Suffix:
Gender:M
Credentials:HEALTH EDUC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-5401
Mailing Address - Country:US
Mailing Address - Phone:561-303-5519
Mailing Address - Fax:
Practice Address - Street 1:1111 W CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-5401
Practice Address - Country:US
Practice Address - Phone:561-303-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2243136291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory