Provider Demographics
NPI:1003897216
Name:BONILLA-COOKE, CRISTINA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:L
Last Name:BONILLA-COOKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:L
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:CCHS PHYSICIAN CONTRACTING, SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 SLEEPY HOLLOW DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5838
Practice Address - Country:US
Practice Address - Phone:302-449-3100
Practice Address - Fax:302-449-3110
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000444363A00000X
DEC50000444363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant