Provider Demographics
NPI:1447782693
Name:BONILLA, KELSEY ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ALLISON
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ALLISON
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-9718
Mailing Address - Fax:310-423-9958
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 603
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4178
Practice Address - Country:US
Practice Address - Phone:310-423-9718
Practice Address - Fax:310-423-9958
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA186284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program