1083086946 NPI number — MRS. KARLA MARIA BONILLA CHICO D.D.S.

Table of content: MRS. KARLA MARIA BONILLA CHICO D.D.S. (NPI 1083086946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083086946 NPI number — MRS. KARLA MARIA BONILLA CHICO D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONILLA CHICO
Provider First Name:
KARLA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083086946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4364 BONITA RD # 233
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91902-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PRIVADA MONTE EVEREST 1982-14
Provider Second Line Business Practice Location Address:
RESIDENCIAL LA CUSPIDE
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22150
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
0011526646858610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3976114 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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