Provider Demographics
NPI:1144245895
Name:BONILLA, VICTOR ORLANDO (MD, FACC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ORLANDO
Last Name:BONILLA
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3831
Mailing Address - Country:US
Mailing Address - Phone:916-783-7109
Mailing Address - Fax:916-781-2882
Practice Address - Street 1:2261 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3831
Practice Address - Country:US
Practice Address - Phone:916-783-7109
Practice Address - Fax:916-783-2882
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51183207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C99181Medicare UPIN
00C511830Medicare PIN