Elmer Otoniel Bonilla, MD. LSA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

SA00543 Issued in TX

Practice address

15411 Hope Shadow CT
Cypress, TX 77429-6237

Phone

(281) 653-2924

Fax

(832) 237-5655

NPI assigned

Jun 11, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• OB Surgical Assistants LLC

  • Surgical Physician Assistant
  • Cypress, TX
  • NPI 1659962074
  NPD Authorized official
• Houston Surgical Assistant Services

  • Surgery Physician
  • Houston, TX
  • NPI 1184703902
  NPD (past)
• Houston Surgical Assistant Services, Inc.

  • Surgical Physician Assistant
  • Houston, TX
  • NPI 1861758609

  Surgery

  NPD (past)

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1619315769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 691789",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772691789",
            "telephone_number": "832-237-5656",
            "fax_number": "832-237-5655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15411 HOPE SHADOW CT",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774296237",
            "telephone_number": "281-653-2924",
            "fax_number": "832-237-5655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "ELMER",
        "middle_name": "OTONIEL",
        "credential": "MD. LSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-11",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "SA00543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Boddeker
• Susel Bofill Garcia
• Boijj Oasis Living
• Taylor Bolchoz
• Barbara Bonaventure
• Stephanie R Booker, LPC, LSOTP
• Katy Layne Boren, MPAS, PA-C
• Lilian Bosire, APRN-FNP-BC
• Botanic Surgical Group, LLC
• Sharleen Botero, FNP-C

• Surgery Physician in Cypress, TX
• Providers in Cypress, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.