Provider Demographics
NPI:1447549530
Name:SHEILA M BONILLA MD INC
Entity type:Organization
Organization Name:SHEILA M BONILLA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-570-1001
Mailing Address - Street 1:622 W DUARTE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9269
Mailing Address - Country:US
Mailing Address - Phone:626-445-1853
Mailing Address - Fax:626-445-8627
Practice Address - Street 1:622 W DUARTE RD STE 108
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9269
Practice Address - Country:US
Practice Address - Phone:264-451-8536
Practice Address - Fax:626-445-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69281261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty