MEDICARE: MRS. SHARON CASTILLO BONILLA LMSW-IPR

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	171M00000X	Case Manager/Care Coordinator	32260	TX

General Provider Information

NPI Number	:	1285886812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON CASTILLO BONILLA LMSW-IPR

Provider Business Mailing Address
First Line	:	2707 TURQUOISE WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1730
Country	:	US
Telephone Number	:	210-378-0601
Fax Number	:	210-682-2601

Provider Business Practice Location Address
First Line	:	2707 TURQUOISE WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1730
Country	:	US
Telephone Number	:	210-378-0601
Fax Number	:	210-682-2601

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

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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