Individual
DR. GABRIEL L BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2526 W RANCHO LAREDO DR, PHOENIX, AZ 85085-7168
(928) 600-6762
Mailing address
2526 W RANCHO LAREDO DR, PHOENIX, AZ 85085-7168
(928) 600-6762
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
32912
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
862913
—
AZ
Enumeration date
02/06/2006
Last updated
05/01/2020
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