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General NPI Number Information
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NPI Number | 1588811442
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Entity Type | Individual
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Provider Name | VALENTIN BONILLA JR. PA
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Gender | Male
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 160 WATER ST 2420
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City | NEW YORK
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State | NY
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Zip | 10038-4922
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Country | US
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Telephone | 212-256-2602
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Fax | 212-256-2609
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Provider Business Mailing Address
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Address Line | 23B COOPER PL
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City | BRONX
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State | NY
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Zip | 10475-2805
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Country | US
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Telephone | 917-856-6274
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Fax | 212-256-2609
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 000569-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 000569
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License Number State | NY
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