Provider Demographics
NPI:1003242207
Name:BONILLA, YANISSE LEONOR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YANISSE
Middle Name:LEONOR
Last Name:BONILLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:15935 SW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1923
Mailing Address - Country:US
Mailing Address - Phone:786-226-3539
Mailing Address - Fax:
Practice Address - Street 1:8940 N KENDALL DR STE 101E
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2166
Practice Address - Country:US
Practice Address - Phone:305-667-8686
Practice Address - Fax:305-667-8680
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9107385363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical