Provider Demographics
NPI:1437726189
Name:SANDOVAL DE BONHOMME, NURYS A
Entity Type:Individual
Prefix:
First Name:NURYS
Middle Name:A
Last Name:SANDOVAL DE BONHOMME
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 1:18181 NE 31ST CT APT 1403
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-1928
Mailing Address - Country:US
Mailing Address - Phone:305-457-2432
Mailing Address - Fax:
Practice Address - Street 1:18181 NE 31ST CT APT 1403
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-1928
Practice Address - Country:US
Practice Address - Phone:305-457-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54942225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist