Individual
CARLOS EDUARDO BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1443 WEST 800 NORTH, SUITE #302, OREM, UT 84057-3658
(801) 235-0953
Mailing address
3527 NEWLAND LOOP, LEHI, UT 84043-4617
(801) 592-9350
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5250948-4405
UT
Other
Enumeration date
09/21/2017
Last updated
03/17/2018
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