Jacob Bonilla

Individual provider Medical Physician Assistant · NPI 1417300096

Jacob Bonilla is a Physician Assistant in Douglas, Arizona. Qualified in 2011, 15 years ago. Practices with Benson Hospital Corporation, a 19-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying: 15
In the registry since: 2016

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1608 S Kings Hwy
Douglas, AZ 85607
Phone: (520) 805-8162

Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

2817 Reilly St, Fort Bragg, NC 28310-8922 — (910) 907-8922

Specialties & licences

Medical Physician Assistant (primary)	Taxonomy 363AM0700X

Record details

NPI number	1417300096
Entity type	Individual (Type 1)
Gender	Male
Sole proprietor	Yes
NPI enumerated	July 19, 2016
Last updated in NPPES	March 21, 2022
Certification date	March 8, 2022
Mailing address	2817 Reilly St, Fort Bragg, NC 28310-8922

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialty	PHYSICIAN ASSISTANT
Medical school	OTHER
Graduated	2011 (15 years in practice)
Group practice	Benson Hospital Corporation — 19 clinicians
Accepts Medicare assignment	Yes — accepts the Medicare-approved amount