Provider Demographics
NPI:1700518735
Name:HERNANDEZ BONILLA, ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:HERNANDEZ BONILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 E COUNTY ROAD 540A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3735
Mailing Address - Country:US
Mailing Address - Phone:863-940-9990
Mailing Address - Fax:
Practice Address - Street 1:1045 E COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3735
Practice Address - Country:US
Practice Address - Phone:863-940-9990
Practice Address - Fax:863-644-3171
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22808208D00000X
FLACN1449208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice