Provider Demographics
NPI:1336110139
Name:BONILLA, ROSELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSELYN
Middle Name:
Last Name:BONILLA
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 1:230 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4452
Mailing Address - Country:US
Mailing Address - Phone:305-888-2607
Mailing Address - Fax:305-888-5161
Practice Address - Street 1:230 PARK ST
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4452
Practice Address - Country:US
Practice Address - Phone:305-888-2607
Practice Address - Fax:305-888-5161
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91321207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50090Medicare ID - Type Unspecified
FLHO9722Medicare UPIN
NYOH1922Medicare ID - Type Unspecified