Basic Information
| Provider Information | |||||||||
| NPI: | 1659867448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONILLA HERNANDEZ | ||||||||
| FirstName: | LUISA | ||||||||
| MiddleName: | FERNANDA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 903 W MARTIN ST # MS 52-2 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782070903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103585909 | ||||||||
| FaxNumber: | 2103584765 | ||||||||
| Practice Location | |||||||||
| Address1: | 4503 S ZARZAMORA ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782111207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106448600 | ||||||||
| FaxNumber: | 2106448625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2018 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | T0727 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.