Individual
CHARLES EDWARD BONFANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
630 PASEO DEL PUEBLO SUR, SUITE 150, TAOS, NM 87571-6070
(575) 758-3005
(575) 758-7010
Mailing address
PO BOX 158, SUITE 150, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 747-7396
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
75-PA002
NM
Other
Enumeration date
04/28/2006
Last updated
02/03/2017
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