Provider Demographics
NPI:1457550550
Name:BUONOMO, BLANCA E (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:E
Last Name:BUONOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PARQ INTERAMERICANA
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-7337
Mailing Address - Country:US
Mailing Address - Phone:787-866-0906
Mailing Address - Fax:787-866-3399
Practice Address - Street 1:71 PARQ INTERAMERICANA
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-7337
Practice Address - Country:US
Practice Address - Phone:787-866-0906
Practice Address - Fax:787-866-3399
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine