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General NPI Number Information
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NPI Number | 1467497792
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Entity Type | Individual
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Provider Name | CLAUDINA A BONILLA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 301 MEMORIAL MEDICAL PKWY
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5167
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Country | US
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Telephone | 407-883-0655
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 547771
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City | ORLANDO
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State | FL
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Zip | 32854-7771
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Country | US
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Telephone | 407-883-0655
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Fax |
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME0069669
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | ME069669
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 040321
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License Number State | GA
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