Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | MD.204149 | LA |
NPI | 1013177013 |
---|---|
Provider Name | Jonathan Bonilla |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 12/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03208741 | (05) | MS |
1105023 | (05) | LA |