Provider Demographics
NPI:1346346590
Name:BONILLA, AIDA L
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:L
Last Name:BONILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VISTA DEL RIO
Mailing Address - Street 2:BLOQUE N-4
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0518
Mailing Address - Country:US
Mailing Address - Phone:787-826-9292
Mailing Address - Fax:787-826-9393
Practice Address - Street 1:405 PASEO DEL RIO SHOPPING MALL
Practice Address - Street 2:STE. 3
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-0518
Practice Address - Country:US
Practice Address - Phone:787-826-9292
Practice Address - Fax:787-826-9393
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4892183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician