Provider Demographics
NPI:1881345718
Name:BONILLA-NEGRON, JOSE A
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:BONILLA-NEGRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 MEMORY LN STE 500
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7489
Mailing Address - Country:US
Mailing Address - Phone:419-618-1135
Mailing Address - Fax:
Practice Address - Street 1:2025 MEMORY LN STE 500
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-7489
Practice Address - Country:US
Practice Address - Phone:419-618-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician