Healthcare Provider Details

I. General information

NPI: 1902784408
Provider Name (Legal Business Name): MILDRED BONILLA CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6547 SW 116TH PL APT A
MIAMI FL
33173-1741
US

IV. Provider business mailing address

6547 SW 116TH PL APT A
MIAMI FL
33173-1741
US

V. Phone/Fax

Practice location:
  • Phone: 786-477-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMW495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: