Provider Demographics
NPI:1396871893
Name:BONILLA, DANIEL ROBLES (RNFA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBLES
Last Name:BONILLA
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 POINTE W
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5032
Mailing Address - Country:US
Mailing Address - Phone:559-674-9076
Mailing Address - Fax:559-674-9076
Practice Address - Street 1:26 POINTE W
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5032
Practice Address - Country:US
Practice Address - Phone:559-674-9076
Practice Address - Fax:559-674-9076
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503329163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant