Provider Demographics
NPI:1649362112
Name:TORRES-BONILLA, GISELA (MD)
Entity type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:TORRES-BONILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GISELA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5210 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4518
Mailing Address - Country:US
Mailing Address - Phone:813-882-9986
Mailing Address - Fax:813-341-3259
Practice Address - Street 1:4700 N HABANA AVE STE 303
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7118
Practice Address - Country:US
Practice Address - Phone:813-341-3285
Practice Address - Fax:813-341-3284
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088743207N00000X
FLME108096207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024105000Medicaid