Basic Information
| Provider Information | |||||||||
| NPI: | 1316113350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONET | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | P.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 WEST AVE | ||||||||
| Address2: | #1009 | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331390900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054957793 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4308 ALTON RD | ||||||||
| Address2: | SUITE 830 | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331404556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055322411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2008 | ||||||||
| LastUpdateDate: | 10/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA 9104491 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.