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General NPI Number Information
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NPI Number | 1689472706
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Entity Type | Individual
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Provider Name | GERSHWIN BONIAO CRUZABRA FNP-C
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Gender | Male
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 134 ELMHURST STE 100
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City | KYLE
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State | TX
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Zip | 78640-6060
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Country | US
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Telephone | 512-268-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 408 W 45TH ST
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City | AUSTIN
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State | TX
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Zip | 78751-3014
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Country | US
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Telephone | 512-451-5800
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1193622
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License Number State | TX
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