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General NPI Number Information
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NPI Number | 1063506871
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Entity Type | Organization
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Legal Business Name | JOSE V. BONILLA AND ASSOCIATES
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 343 W HOUSTON ST SUITE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2107
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Country | US
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Telephone | 210-222-0289
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Fax | 210-222-9825
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Provider Business Mailing Address
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Address Line | 343 W HOUSTON ST SUITE 105
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2107
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Country | US
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Telephone | 210-222-0289
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Fax | 210-222-9825
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE VICENTE BONILLA
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Credential | M.D.
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Telephone | 210-222-0289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D3156
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License Number State | TX
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