Provider Demographics
NPI:1386300267
Name:BONOAN, VICTOR (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:BONOAN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 SUMMER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2911
Mailing Address - Country:US
Mailing Address - Phone:832-641-0650
Mailing Address - Fax:
Practice Address - Street 1:7877 WILLOW CHASE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5934
Practice Address - Country:US
Practice Address - Phone:832-869-4818
Practice Address - Fax:832-241-2902
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058668363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health