Provider Demographics
NPI:1245225663
Name:BONELLI, ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:BONELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331248
Mailing Address - Street 2:1521 S. STAPLES
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-1248
Mailing Address - Country:US
Mailing Address - Phone:361-882-1917
Mailing Address - Fax:361-882-7507
Practice Address - Street 1:3210 REID DR
Practice Address - Street 2:STE M
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2524
Practice Address - Country:US
Practice Address - Phone:361-882-1917
Practice Address - Fax:361-882-7507
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9569207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099781902Medicaid
QC14OtherBCBS
00QC14Medicare ID - Type Unspecified
TX099781902Medicaid