Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 77974 | MA |
NPI | 1245298215 |
---|---|
Provider Name | Francisco A Bonilla |
First Address | Leominster, MA 01453-1805 |
Second Address | Leominster, MA 01453-1805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F97260 | (02) | MA |