Provider Demographics
NPI:1598969198
Name:BONILLAS, ROBERT GRANILLO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GRANILLO
Last Name:BONILLAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9377 E BELL RD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1502
Mailing Address - Country:US
Mailing Address - Phone:480-245-6380
Mailing Address - Fax:480-245-6382
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 367
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-245-6380
Practice Address - Fax:480-245-6382
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2015-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ409942086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery