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General NPI Number Information
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NPI Number | 1760250351
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Entity Type | Organization
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Legal Business Name | BONITO SOL LLC
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 1613 S CAPITAL OF TEXAS HWY STE 224
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City | AUSTIN
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State | TX
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Zip | 78746-7398
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Country | US
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Telephone | 737-291-1804
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Fax |
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Provider Business Mailing Address
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Address Line | 14717 MARCHESA DR
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City | AUSTIN
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State | TX
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Zip | 78738-4406
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Country | US
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Telephone | 512-731-0461
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DARYL RUYBAL
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Credential |
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Telephone | 512-731-0461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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