Provider Demographics
NPI:1144206871
Name:RIVERA BONILLA, ILEANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:
Last Name:RIVERA BONILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A3 AVE PEREZ ANDINO
Mailing Address - Street 2:URB VILLAS DE RIO GRANDE
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-888-2302
Mailing Address - Fax:
Practice Address - Street 1:VILLAS DE SAN AGUSTIN
Practice Address - Street 2:CALLE 2 A 13
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-786-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10742208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics