Provider Demographics
NPI:1235530056
Name:BONILLA, MARIA LUISA (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LUISA
Last Name:BONILLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 FM 1960 RD W
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4600
Mailing Address - Country:US
Mailing Address - Phone:832-573-1133
Mailing Address - Fax:281-596-7211
Practice Address - Street 1:4606 FM 1960 RD W
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4600
Practice Address - Country:US
Practice Address - Phone:832-573-1133
Practice Address - Fax:281-596-7211
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor