Provider Demographics
NPI:1568274652
Name:BONACHEA, REINIER GUSTAVO
Entity type:Individual
Prefix:
First Name:REINIER
Middle Name:GUSTAVO
Last Name:BONACHEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13105 SW 248TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6055
Mailing Address - Country:US
Mailing Address - Phone:786-303-8969
Mailing Address - Fax:
Practice Address - Street 1:1990 SW 27TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2547
Practice Address - Country:US
Practice Address - Phone:305-890-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB520727861740225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist