Provider Demographics
NPI:1437487972
Name:ANDRES BONELLI, MD
Entity Type:Organization
Organization Name:ANDRES BONELLI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:BONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-882-1917
Mailing Address - Street 1:PO BOX 331248
Mailing Address - Street 2:
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 1:1521 S. STAPLES
Practice Address - Street 2:#403
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-882-1917
Practice Address - Fax:361-882-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099781902Medicaid
B21372Medicare UPIN
OOQC14Medicare PIN