Individual
DEREK LEE BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1206 W WELLINGTON DR, DELTONA, FL 32725-7036
(407) 314-3351
Mailing address
1206 W WELLINGTON DR, DELTONA, FL 32725-7036
(407) 314-3351
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
57436
FL
Other
Enumeration date
10/14/2021
Last updated
10/14/2021
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