| Bonita Cosmetic Llc | |
|
7820 N Armenia Ave Ste B Tampa FL 33604-3852 | |
| (813) 931-0024 | |
| (813) 931-0026 |
| Full Name | Bonita Cosmetic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7820 N Armenia Ave Ste B, Tampa, Florida |
| Authorized Official Name and Position | Oriberto Iparraguirre Gongora (AMBR) |
| Authorized Official Contact | 8139310024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonita Cosmetic Llc 405 Loch Devon Dr Lutz FL 33548-4282 Ph: () - | Bonita Cosmetic Llc 7820 N Armenia Ave Ste B Tampa FL 33604-3852 Ph: (813) 931-0024 |
| NPI Number | 1164177721 |
|---|---|
| Provider Enumeration Date | 02/12/2022 |
| Last Update Date | 02/12/2022 |
| Medicare PECOS PAC ID | 6103204821 |
|---|---|
| Medicare Enrollment ID | O20220914003167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164177721 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Oriberto Iparraguirre Gongora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649888769 PECOS PAC ID: 9931513884 Enrollment ID: I20220914003419 |
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