Provider Demographics
NPI:1073271391
Name:BONA, LUCIA S
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:S
Last Name:BONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BROOKE ST
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5076
Mailing Address - Country:US
Mailing Address - Phone:512-587-3477
Mailing Address - Fax:
Practice Address - Street 1:131 BROOKE ST
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5076
Practice Address - Country:US
Practice Address - Phone:512-587-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 261QA0600X
TX021560251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care