Bonita Beach Medical Group LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BONITA BEACH MEDICAL GROUP LLC

Doing business as

Bonita Beach Medical Group LLC

Practice address

3431 Bonita Beach Rd Unit 406
Bonita Springs, FL 34134-4153

Phone

(239) 888-9818

Fax

(239) 326-0467

NPI assigned

Jan 22, 2021

Organization subpart

No

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

Authorized official

Name

Bogdan-Gabriel Cozmuta, PA

Title

Manager

Phone

(203) 558-0836

Specialties & licenses 1

Addresses

Other names 1

• Bonita Beach Medical Group LLC Doing business as

Locations

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

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1255921318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3431 BONITA BEACH RD UNIT 406",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341344153",
            "telephone_number": "239-888-9818",
            "fax_number": "239-326-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3431 BONITA BEACH RD UNIT 406",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341344153",
            "telephone_number": "239-888-9818",
            "fax_number": "239-326-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONITA BEACH MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "COZMUTA",
        "authorized_official_first_name": "BOGDAN-GABRIEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "203-558-0836",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bonita Beach Medical Group LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David R Boerkoel, OTR
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• Bonita Dermatology, P.a.

• Family Medicine Physician in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.