Provider Demographics
NPI:1003934555
Name:BONILLA, ANGELISA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELISA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELISA
Other - Middle Name:BONILLA
Other - Last Name:FRANCESCHINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7 CALLE 1
Mailing Address - Street 2:TERRS DE TINTILLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1645
Mailing Address - Country:US
Mailing Address - Phone:787-502-5784
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE 1
Practice Address - Street 2:TERRS DE TINTILLO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1645
Practice Address - Country:US
Practice Address - Phone:787-269-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7978207ZP0102X, 209800000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Not Answered209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Not Answered291U00000XLaboratoriesClinical Medical Laboratory