Provider Demographics
NPI:1346631611
Name:BONILLA, JOSEPH (PHD, RD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:BONILLA
Suffix:
Gender:M
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 LOCKHILL SELMA RD
Mailing Address - Street 2:1602
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3066
Mailing Address - Country:US
Mailing Address - Phone:210-241-0598
Mailing Address - Fax:
Practice Address - Street 1:2423 LOCKHILL SELMA RD
Practice Address - Street 2:1602
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3066
Practice Address - Country:US
Practice Address - Phone:210-241-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered