Provider Demographics
NPI:1194195800
Name:BONILLA, CINTHYA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CINTHYA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 QUAIL HOLW
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-7117
Mailing Address - Country:US
Mailing Address - Phone:973-280-1716
Mailing Address - Fax:
Practice Address - Street 1:2650 BAHIA VISTA ST STE 106
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2611
Practice Address - Country:US
Practice Address - Phone:973-280-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68122225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist