MEDICARE: DR. ROSELYN BONILLA M.D.

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	207V00000X	Obstetrics & Gynecology Physician	ME91321	FL

General Provider Information

NPI Number	:	1336110139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSELYN BONILLA M.D.

Provider Business Mailing Address
First Line	:	230 PARK ST
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-4452
Country	:	US
Telephone Number	:	305-888-2607
Fax Number	:	305-888-5161

Provider Business Practice Location Address
First Line	:	230 PARK ST
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-4452
Country	:	US
Telephone Number	:	305-888-2607
Fax Number	:	305-888-5161

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	02/01/2013

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