Provider Demographics
NPI:1104865914
Name:RODRIGUEZ BONILLA, TERESA (RDN IFNCP LDN, CLT)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:RODRIGUEZ BONILLA
Suffix:
Gender:F
Credentials:RDN IFNCP LDN, CLT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN IFNCP LDN, CLT
Mailing Address - Street 1:113 CALLE MALLORCA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3125
Mailing Address - Country:US
Mailing Address - Phone:727-366-9663
Mailing Address - Fax:317-427-6078
Practice Address - Street 1:113 CALLE MALLORCA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3125
Practice Address - Country:US
Practice Address - Phone:727-366-9663
Practice Address - Fax:317-427-6078
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3736133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered