Provider Demographics
NPI:1790856169
Name:CEBALLOS BONANO, CARMEN E (RN)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:E
Last Name:CEBALLOS BONANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CALLE DEL CARMEN W
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4717
Mailing Address - Country:US
Mailing Address - Phone:787-860-3558
Mailing Address - Fax:787-860-7066
Practice Address - Street 1:55 CALLE DEL CARMEN W
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4717
Practice Address - Country:US
Practice Address - Phone:787-860-3558
Practice Address - Fax:787-860-7066
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR013101163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator