Individual
MAGGIE M. BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
840 SW 4TH AVE STE 105, ONTARIO, OR 97914-2638
(541) 881-2800
(541) 881-2825
Mailing address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9598
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO219284
OR
208000000X
Pediatrics Physician
14735A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500840592
—
OR
Enumeration date
04/28/2017
Last updated
01/13/2026
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