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NPI Code Detail

MEDICARE: JOSE A BONILLA-NEGRON

MEDICARE: JOSE A BONILLA-NEGRON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1881345718
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE A BONILLA-NEGRON
Provider Business Mailing Address
First Line : 2025 MEMORY LN STE 500
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-7489
Country : US
Telephone Number : 419-618-1135
Fax Number :
Provider Business Practice Location Address
First Line : 2025 MEMORY LN STE 500
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-7489
Country : US
Telephone Number : 419-618-1135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2022
Last Update Date : 01/12/2022

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Directions to “ JOSE A BONILLA-NEGRON ” Practice Location

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