Individual
JACOB BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1608 S. KINGS HWY, DOUGLAS, AZ 85607
(520) 805-8162
Mailing address
2817 REILLY ST, FORT BRAGG, NC 28310-8922
(910) 907-8922
(910) 907-6069
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
07/19/2016
Last updated
03/21/2022
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