Provider Demographics
NPI:1972183515
Name:BONILLA-FERMIN, RAFAEL
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:BONILLA-FERMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 HANSBERRY CT NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3818
Mailing Address - Country:US
Mailing Address - Phone:120-228-5124
Mailing Address - Fax:202-636-3728
Practice Address - Street 1:3801 HANSBERRY CT NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3818
Practice Address - Country:US
Practice Address - Phone:202-285-1246
Practice Address - Fax:202-636-3728
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant