Healthcare Provider Details

I. General information

NPI: 1235394230
Provider Name (Legal Business Name): MELISSA AJUNWA BOHONOS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA OBIAGELI AJUNWA MD

II. Dates (important events)

Enumeration Date: 07/20/2008
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 SAN PEDRO AVE STE 123
SAN ANTONIO TX
78232-3063
US

IV. Provider business mailing address

16111 SAN PEDRO AVE STE 123
SAN ANTONIO TX
78232-3063
US

V. Phone/Fax

Practice location:
  • Phone: 210-729-0544
  • Fax: 210-729-0545
Mailing address:
  • Phone: 210-729-0544
  • Fax: 217-383-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberS7013
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberS7013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: