Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JACOB BONILLA
Active Sole ProprietorJACOB BONILLA is a Medical Physician Assistant healthcare provider located in DOUGLAS, Arizona. NPI 1417300096 is currently active in the NPPES registry. Verify at CMS.
Medical Physician Assistant · DOUGLAS, AZ
Registration Details
- NPI Number
- 1417300096
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 19, 2016 (10.11257396816 yrs)
- Last Updated
- Mar 21, 2022
- Sole Proprietor
- Yes
Practice Information
- Address
-
1608 S. KINGS HWYDOUGLAS, AZ, 85607Browse AZ providers · Browse ZIP 85607
- Phone
- 5208058162
- Primary Specialty
-
Medical Physician Assistant
363AM0700X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.