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NPI Code Detail

MEDICARE: SESAR JESUS BONILLA

MEDICARE: SESAR JESUS BONILLA
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
11041C0700XClinical Social Worker72152MT

General Provider Information

NPI Number : 1477387843
Entity Type Code : Individual
Provider Name (Legal Business Name) : SESAR JESUS BONILLA
Provider Business Mailing Address
First Line : 2244 E VISTA DR
Second Line :
City : MISSOULA
State : MT
Zip : 59803-2620
Country : US
Telephone Number : 406-208-4788
Fax Number :
Provider Business Practice Location Address
First Line : 9801 VALLEY GROVE DR APT D
Second Line :
City : LOLO
State : MT
Zip : 59847-8617
Country : US
Telephone Number : 406-273-4633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2024
Last Update Date : 08/28/2024

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Directions to “ SESAR JESUS BONILLA ” Practice Location

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