Provider Demographics
NPI:1679920862
Name:SCOTTSDALE PLASTICS, PLLC
Entity Type:Organization
Organization Name:SCOTTSDALE PLASTICS, PLLC
Other - Org Name:SCOTTSDALE PLASTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GRANILLO
Authorized Official - Last Name:BONILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-245-6380
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:85260-1505
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:85260-1505
Practice Address - Country:US
Practice Address - Phone:480-245-6380
Practice Address - Fax:480-245-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ409942086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty