Healthcare Provider Details

I. General information

NPI: 1033869888
Provider Name (Legal Business Name): JESSICA VIRGINIA BONILLA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR # N2198
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

1301 CHANNING PARK CIR
CARY NC
27519-7643
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-5136
  • Fax:
Mailing address:
  • Phone: 407-864-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number334413
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: