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General NPI Number Information
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NPI Number | 1164609285
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Entity Type | Individual
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Provider Name | GERALD BONILLA
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Gender | Male
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 2320 DAIRY RD SUITE 101
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-5208
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Country | US
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Telephone | 321-725-4948
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Fax | 321-725-0831
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Provider Business Mailing Address
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Address Line | 5000 CHESHIRE LN N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3706
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Country | US
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Telephone | 888-333-9152
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Fax | 763-268-4240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS2624
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License Number State | FL
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