=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346409455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIO CESAR GARCIA BONILLA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 12/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 PARADISE RD SUITE E
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95351-3163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-558-4000
-----------------------------------------------------
Fax | 209-558-5036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 PARADISE RD SUITE E
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95351-3163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-558-4000
-----------------------------------------------------
Fax | 209-558-5036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------