Provider Demographics
NPI:1932521846
Name:BONIFACE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BONIFACE
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 1:206 MEADOW GATE DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-0850
Mailing Address - Country:US
Mailing Address - Phone:281-338-9829
Mailing Address - Fax:281-338-9830
Practice Address - Street 1:206 MEADOW GATE DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-0850
Practice Address - Country:US
Practice Address - Phone:281-338-9829
Practice Address - Fax:281-338-9830
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health