Provider Demographics
NPI:1659867448
Name:BONILLA HERNANDEZ, LUISA FERNANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:FERNANDA
Last Name:BONILLA HERNANDEZ
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:903 W MARTIN ST # MS 52-2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:210-358-5909
Mailing Address - Fax:210-358-4765
Practice Address - Street 1:4503 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-1207
Practice Address - Country:US
Practice Address - Phone:210-644-8600
Practice Address - Fax:210-644-8625
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXT0727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics