Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | G04943 | TX |
NPI | 1114991049 |
---|---|
Provider Name | Dr. Raquel Cruz Bono |
First Address | Jacksonville, FL 32212-1171 |
Second Address | Jacksonville, FL 32214-5005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |