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Organization

REGENERATIVE SPINE & JOINT, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GABRIEL BONILLA M.D. (OWNER)
(928) 600-6762
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
208VP0000X
Pain Medicine Physician

Other

Enumeration date
10/15/2014
Last updated
10/15/2014
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