Individual
ELIANA E BONFANTE MEJIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6411 FANNIN ST, HOUSTON, TX 77030-1501
(713) 704-2800
Mailing address
PO BOX 301173, DALLAS, TX 75303-1173
(713) 500-3500
(713) 704-5734
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M5064
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173724901
—
TX
01
—
173724902
CSHCN
TX
01
—
8R0316
BCBS
TX
Enumeration date
06/03/2006
Last updated
07/29/2016
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