Individual
MARICELA BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
500 NORTH MUNDO, DULCE, NM 87528-0187
(575) 759-7281
(575) 759-3651
Mailing address
PO BOX 187, 500 NORTH MUNDO, DULCE, NM 87528-0187
(575) 759-7281
(575) 759-3651
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2334
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23721243
—
NM
01
—
HSZ196
MEDICARE PART B
NM
01
—
K3526
FACILITY MEDICAID
NM
Enumeration date
06/30/2006
Last updated
02/29/2012
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