# REGENERATIVE SPINE & JOINT, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457755845
- **Authorized official:** GABRIEL BONILLA M.D. (OWNER)
- **Authorized official phone:** (928) 600-6762

## Contact information

- **Practice address:** 2338 W SLEEPY RANCH RD, PHOENIX, AZ 85085-7038
- **Practice address phone:** (928) 600-6762
- **Mailing address:** 2338 W SLEEPY RANCH RD, PHOENIX, AZ 85085-7038
- **Mailing address phone:** (928) 600-6762

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 10/15/2014
- **Last updated:** 10/15/2014