Bonita Medical Supply, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

BONITA MEDICAL SUPPLY, INC.

Practice address

4045 Bonita Rd Ste 310
Bonita, CA 91902-1347

Phone

(619) 539-4725

NPI assigned

Oct 6, 2023

Organization subpart

No

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

Authorized official

Name

Mohamed Refaat Mohamed

Title

Ceo

Phone

(619) 539-4725

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1205617214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 BONITA RD STE 310",
            "city": "BONITA",
            "state": "CA",
            "postal_code": "919021347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 BONITA RD STE 310",
            "city": "BONITA",
            "state": "CA",
            "postal_code": "919021347",
            "telephone_number": "619-539-4725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONITA MEDICAL SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-06",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "REFAAT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-539-4725"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lauren Elise Branham
• Christine Buenaventura, DDS

• Prosthetic/Orthotic Supplier in Bonita, CA
• Providers in Bonita, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.