Provider Demographics
NPI:1528145190
Name:NEYDA BONILLA
Entity type:Organization
Organization Name:NEYDA BONILLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/GM
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-683-8181
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-0880
Mailing Address - Country:US
Mailing Address - Phone:956-683-8181
Mailing Address - Fax:956-683-8191
Practice Address - Street 1:2635 W BUSINESS HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-7617
Practice Address - Country:US
Practice Address - Phone:956-683-8181
Practice Address - Fax:956-683-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108060341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164410601Medicaid
TXAMB819OtherBLUE CROSS BLUE SHIELD
TXAMB819OtherBLUE CROSS BLUE SHIELD
TXAMB340Medicare ID - Type UnspecifiedTRAIL BLAZER