Healthcare Provider Details

I. General information

NPI: 1699669358
Provider Name (Legal Business Name): BONATERRA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CUMBERLAND RD
AUSTIN TX
78704-5412
US

IV. Provider business mailing address

PO BOX 680994
HOUSTON TX
77268-0994
US

V. Phone/Fax

Practice location:
  • Phone: 512-441-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GARCIA
Title or Position: PRESIDENT
Credential:
Phone: 512-441-2900