MEDICARE: BONNIE MA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA18162	TX

General Provider Information

NPI Number	:	1053056713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE MA PA-C

Provider Business Mailing Address
First Line	:	5207 BONITA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-6725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5207 BONITA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-6725
Country	:	US
Telephone Number	:	214-984-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	01/17/2026

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Directions to “ BONNIE MA PA-C” Practice Location

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