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NPI Code Detail

MEDICARE: DR. ERNESTO BONILLA M.D.

MEDICARE: DR. ERNESTO 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
1207QA0505XAdult Medicine PhysicianME94228FL

Other Identifiers

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

General Provider Information

NPI Number : 1508850918
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERNESTO BONILLA M.D.
Provider Business Mailing Address
First Line : 2950 CLEVELAND CLINIC BLVD
Second Line :
City : WESTON
State : FL
Zip : 33331-3609
Country : US
Telephone Number : 954-659-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2950 CLEVELAND CLINIC BLVD
Second Line :
City : WESTON
State : FL
Zip : 33331-3609
Country : US
Telephone Number : 954-659-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 11/02/2011

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Directions to “ DR. ERNESTO BONILLA M.D.” Practice Location

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