Individual
DEMARCUS IRVING-BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 ARKANSAS BLVD, TEXARKANA, AR 71854-2105
(870) 772-5028
Mailing address
701 ARKANSAS BLVD, TEXARKANA, AR 71854-2105
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/19/2015
Last updated
10/19/2015
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