Healthcare Provider Details

I. General information

NPI: 1669587325
Provider Name (Legal Business Name): MIAMI SPRINGS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PARK ST
MIAMI SPRINGS FL
33166-4452
US

IV. Provider business mailing address

230 PARK ST
MIAMI SPRINGS FL
33166-4452
US

V. Phone/Fax

Practice location:
  • Phone: 305-888-2607
  • Fax:
Mailing address:
  • Phone: 305-888-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9077
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME91321
License Number StateFL

VIII. Authorized Official

Name: DR. ROSELYN BONILLA
Title or Position: PRESIDENT
Credential: MD
Phone: 305-888-2607