Carlos Eduardo Bonilla, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5250948-4405 Issued in UT

Practice address

1443 West 800 North, Suite #302
Orem, UT 84057-3658

Phone

(801) 235-0953

NPI assigned

Sep 21, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Carlos Eduardo Bonilla Professional name

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1174032122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3527 NEWLAND LOOP",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840434617",
            "telephone_number": "801-592-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1443 WEST 800 NORTH, SUITE #302",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840573658",
            "telephone_number": "801-235-0953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "George E. Wahlen VA Salt Lake City Health Care System",
            "address_2": "500 Foothill Blvd. (00QC)",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "84138",
            "country_code": "US",
            "telephone_number": "801-582-1565 x2062",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "CARLOS",
        "middle_name": "EDUARDO",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-21",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "5250948-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLOS",
            "last_name": "BONILLA",
            "middle_name": "EDUARDO",
            "credential": "APRN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brian T Boden, PAC
• Jadyn Bohn
• Daniel Bolanos
• Samantha Bolton, DNP
• Bryan Felipe Bonilla-Alberto, CSW
• Hailey Jean Booher
• Emmett Carroll Boone
• Caitrin Nicolle Booren
• Krystal Booth
• Alyssa Anne Boren

• Family Nurse Practitioner in Orem, UT
• Providers in Orem, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.