MEDICARE: LUIS ANTONIO BONET RODRIGUEZ

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	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1275332579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS ANTONIO BONET RODRIGUEZ

Provider Business Mailing Address
First Line	:	1811 ARMY BLVD BLDG 2018
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-2686
Country	:	US
Telephone Number	:	346-664-1922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 ARMY BLVD BLDG 2018
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-2686
Country	:	US
Telephone Number	:	346-664-1922
Fax Number	:

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

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Directions to “ LUIS ANTONIO BONET RODRIGUEZ ” Practice Location

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