Healthcare Provider Details

I. General information

NPI: 1427995893
Provider Name (Legal Business Name): LUIS DAVID HIDALGO BONILLA BA, BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 MISSION ST
SAN FRANCISCO CA
94110-3104
US

IV. Provider business mailing address

1147 TREAT AVE
SAN FRANCISCO CA
94110-4123
US

V. Phone/Fax

Practice location:
  • Phone: 628-754-8800
  • Fax:
Mailing address:
  • Phone: 415-608-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: