Provider Demographics
NPI:1811105315
Name:FARIA-BONANO, ANTONIO (MA)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:FARIA-BONANO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CALLE FLAMINGO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9532
Mailing Address - Country:US
Mailing Address - Phone:787-650-6883
Mailing Address - Fax:
Practice Address - Street 1:900 CALLE CERRA
Practice Address - Street 2:CDT GUALBERTO RABELL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-5104
Practice Address - Country:US
Practice Address - Phone:787-723-1360
Practice Address - Fax:787-723-6247
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health