Individual provider · Type 1 NPI
Jacob Bonilla
Medical Physician Assistant · Douglas, AZ
NPI number
1417300096
Active
Practice location
1608 S. Kings Hwy
Douglas, AZ 85607
Mailing address
2817 Reilly St
Fort Bragg, NC 28310-8922
Other practice locations
- 2817 Reilly St, Fort Bragg, NC 28310-8922 · (910) 907-8922
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | None listed |
Medical Physician Assistant: Definition to come...
About NPI 1417300096
Jacob Bonilla's National Provider Identifier is 1417300096, issued on Jul 19, 2016. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Douglas, AZ. The record was last updated on Mar 21, 2022.