Provider Demographics
NPI:1699098327
Name:BONILLA, MARIA DEL REFUGIO (FNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL REFUGIO
Last Name:BONILLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3730
Mailing Address - Country:US
Mailing Address - Phone:559-791-7000
Mailing Address - Fax:559-782-1418
Practice Address - Street 1:1107 WEST POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5839
Practice Address - Country:US
Practice Address - Phone:559-781-7242
Practice Address - Fax:559-793-3542
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily