JACOB BONILLA NPI 1417300096

NPI Information

NPI: 1417300096
Provider Name: JACOB BONILLA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
1608 S. KINGS HWY
DOUGLAS, AZ
ZIP 85607
Phone: (520) 805-8162
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Jacob Bonilla is a medical physician assistant in Douglas, AZ. Jacob Bonilla NPI is 1417300096. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1608 S. KINGS HWY
DOUGLAS, AZ
ZIP 85607
Phone: (520) 805-8162

The enumeration date for this NPI number is 7/19/2016 and was last updated on 3/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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