Provider Demographics
NPI:1083331508
Name:BONILLA BENIQUE, WILMARYS
Entity Type:Individual
Prefix:
First Name:WILMARYS
Middle Name:
Last Name:BONILLA BENIQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WILMARYS
Other - Middle Name:
Other - Last Name:BONILLA BENIQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICO ASISTENTE
Mailing Address - Street 1:PO BOX 1161
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1161
Mailing Address - Country:US
Mailing Address - Phone:939-865-1772
Mailing Address - Fax:
Practice Address - Street 1:CARR 4417 KM 0.3 INTERIOR
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:939-865-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00603OtherMEDICO ASISTENTE