Provider Demographics
NPI:1710166384
Name:CLAUDINA A BONILLA MD FCCP PA
Entity Type:Organization
Organization Name:CLAUDINA A BONILLA MD FCCP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-724-9395
Mailing Address - Street 1:1840 MEASE DR
Mailing Address - Street 2:SUITE # 405
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6602
Mailing Address - Country:US
Mailing Address - Phone:727-724-9395
Mailing Address - Fax:727-724-9626
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE # 405
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-724-9395
Practice Address - Fax:727-724-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069669207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379271400Medicaid
FL379271400Medicaid