Provider Demographics
NPI:1932665445
Name:ROMAN BONEW, ELIAS
Entity Type:Individual
Prefix:MS
First Name:ELIAS
Middle Name:
Last Name:ROMAN BONEW
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:COLINAS DE GUAYNABO, LAUREL
Mailing Address - Street 2:E-20
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-318-4961
Mailing Address - Fax:
Practice Address - Street 1:725053 PROGRAMA SALUD AL DEAMBULANTE
Practice Address - Street 2:900 CALLE CERRA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928
Practice Address - Country:US
Practice Address - Phone:787-480-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse