Provider Demographics
NPI:1427512540
Name:BONITA WELLNESS CENTER
Entity type:Organization
Organization Name:BONITA WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CIURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-992-8555
Mailing Address - Street 1:8951 BONITA BEACH RD SE STE 206
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4202
Mailing Address - Country:US
Mailing Address - Phone:239-992-8555
Mailing Address - Fax:239-992-8644
Practice Address - Street 1:8951 BONITA BEACH RD SE STE 206
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4202
Practice Address - Country:US
Practice Address - Phone:239-992-8555
Practice Address - Fax:239-992-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty