MEDICARE: MARIA BELEN RIVERA-BONILLA MD

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	207R00000X	Internal Medicine Physician	ME122431	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215248364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA BELEN RIVERA-BONILLA MD

Provider Business Mailing Address
First Line	:	500 E CENTRAL AVE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3094
Country	:	US
Telephone Number	:	863-293-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	199 AVENUE B NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4546
Country	:	US
Telephone Number	:	863-293-1191
Fax Number	:

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

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	09/30/2019

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