Provider Demographics
NPI:1356660831
Name:BONILLA, RICHARD (RCS, CVT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BONILLA
Suffix:
Gender:M
Credentials:RCS, CVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16510 SW 96TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5832
Mailing Address - Country:US
Mailing Address - Phone:305-388-3182
Mailing Address - Fax:786-472-4520
Practice Address - Street 1:16510 SW 96TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-5832
Practice Address - Country:US
Practice Address - Phone:305-388-3182
Practice Address - Fax:786-472-4520
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00069740246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography