Provider Demographics
NPI:1982322665
Name:BONET, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:BONET
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 1:6161 NW 2ND AVE APT 223
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2011
Mailing Address - Country:US
Mailing Address - Phone:561-213-3419
Mailing Address - Fax:
Practice Address - Street 1:7711 N MILITARY TRL STE 201
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6506
Practice Address - Country:US
Practice Address - Phone:561-812-8666
Practice Address - Fax:561-944-3444
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-02-15
Deactivation Date:2024-02-04
Deactivation Code:
Reactivation Date:2024-02-15
Provider Licenses
StateLicense IDTaxonomies
FL52520225700000X
FLRBT-23-314904106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist