| Bonita Family Care, Inc | |
|
10459 Reynolds St Bonita Springs FL 34135-5535 | |
| (239) 992-4344 | |
| (239) 992-5042 |
| Full Name | Bonita Family Care, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 10459 Reynolds St, Bonita Springs, Florida |
| Authorized Official Name and Position | Domingo Feliciano (OWNER) |
| Authorized Official Contact | 2399924344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonita Family Care, Inc Po Box 366734 Bonita Springs FL 34136-6734 Ph: (239) 992-4344 | Bonita Family Care, Inc 10459 Reynolds St Bonita Springs FL 34135-5535 Ph: (239) 992-4344 |
| NPI Number | 1902912850 |
|---|---|
| Provider Enumeration Date | 08/22/2006 |
| Last Update Date | 06/19/2008 |
| Medicare PECOS PAC ID | 7214839539 |
|---|---|
| Medicare Enrollment ID | O20040126000533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902912850 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME63084 (Florida) | Primary |
| Provider Name | Domingo Feliciano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962589010 PECOS PAC ID: 6103711668 Enrollment ID: I20111004000141 |
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