MEDICARE: MARIAL ESCOTO BONILLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1164559464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAL ESCOTO BONILLAS

Provider Business Mailing Address
First Line	:	2138 S 14TH ST
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4326
Country	:	US
Telephone Number	:	760-353-1436
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 S WATERMAN AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4142
Country	:	US
Telephone Number	:	760-353-1436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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Directions to “ MARIAL ESCOTO BONILLAS ” Practice Location

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