Provider Demographics
NPI:1760440200
Name:BONUEL, NIDA E (MD)
Entity Type:Individual
Prefix:
First Name:NIDA
Middle Name:E
Last Name:BONUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:2825 SIENA HEIGHTS DR STE 101
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5488
Practice Address - Country:US
Practice Address - Phone:702-616-7049
Practice Address - Fax:702-492-1467
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7502OtherSTATE LICENSE
NV1760440200Medicaid
NVP00367728OtherRAIL ROAD MEDICARE
NVG08414Medicare UPIN
NV102515Medicare PIN
NV1760440200Medicaid