=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528145190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEYDA BONILLA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 06/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2635 W BUSINESS HIGHWAY 83
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-7617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-683-8181
-----------------------------------------------------
Fax | 956-683-8181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 880
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78505-0880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-683-8181
-----------------------------------------------------
Fax | 956-683-8191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/GM
-----------------------------------------------------
Name | MRS. NEYDA BONILLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-683-8181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 108060
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------