Healthcare Provider Details

I. General information

NPI: 1063507606
Provider Name (Legal Business Name): BONITA SOPHIA NEUMON-OWENS MPAS-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER
SAN ANTONIO TX
78228
US

IV. Provider business mailing address

9515 MANDALAY WAY
HELOTES TX
78023-4611
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax: 210-617-5271
Mailing address:
  • Phone: 210-617-5300
  • Fax: 210-617-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2382
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: