Healthcare Provider Details

I. General information

NPI: 1598969198
Provider Name (Legal Business Name): ROBERT GRANILLO BONILLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 E BELL RD SUITE 367
SCOTTSDALE AZ
85260-1502
US

IV. Provider business mailing address

9377 E BELL RD SUITE 367
SCOTTSDALE AZ
85260-1502
US

V. Phone/Fax

Practice location:
  • Phone: 480-245-6380
  • Fax: 480-245-6382
Mailing address:
  • Phone: 480-245-6380
  • Fax: 480-245-6382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number40994
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: