Provider Demographics
NPI:1114945748
Name:BONILLA, DEBORAH E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:E
Last Name:BONILLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEO DE LAS CUMBRES 345 CARR.850 APT.48
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3432
Mailing Address - Country:US
Mailing Address - Phone:787-292-3651
Mailing Address - Fax:
Practice Address - Street 1:BERNARDO GARCIA ST #55 N
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical