| NPI | 1982017273 |
|---|---|
| Doing Business As | EDWIN R. BONILLA, M.D. |
| Entity Type | Organization |
| Authorized Contact | DARRELL L KINGHAM CFO 337-462-7111 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-06-04 |