MEDICARE: GERARDO BONILLA B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1568647246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO BONILLA B.S.

Provider Business Mailing Address
First Line	:	506 E FAIRVIEW AVE
Second Line	:	A
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3039
Country	:	US
Telephone Number	:	626-898-3316
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 E FAIRVIEW AVE
Second Line	:	A
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3039
Country	:	US
Telephone Number	:	626-898-3316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2007
Last Update Date	:	06/03/2013

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