Provider Demographics
NPI:1053008318
Name:COMPASS NEPHROLOGY CARE, PLLC
Entity type:Organization
Organization Name:COMPASS NEPHROLOGY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:BONANNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-590-0556
Mailing Address - Street 1:2685 EXECUTIVE PARK DR STE 5
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3651
Mailing Address - Country:US
Mailing Address - Phone:954-590-0556
Mailing Address - Fax:
Practice Address - Street 1:2685 EXECUTIVE PARK DR STE 5
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3651
Practice Address - Country:US
Practice Address - Phone:954-590-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty