Provider Demographics
NPI:1275572406
Name:MENDEZ-BONILLA, CRISTOBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:
Last Name:MENDEZ-BONILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 CALLE VILA MAYO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2110
Mailing Address - Country:US
Mailing Address - Phone:787-717-7315
Mailing Address - Fax:787-725-9307
Practice Address - Street 1:ASHFORD MEDICAL CTR
Practice Address - Street 2:29 CALLE WASHINGTON SUITE # 606
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-723-4966
Practice Address - Fax:787-724-6550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4419207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08358Medicare UPIN