Provider Demographics
NPI:1396848537
Name:BONILLA, MABEL M (MD)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:M
Last Name: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:PO BOX 6676
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6676
Mailing Address - Country:US
Mailing Address - Phone:787-908-6600
Mailing Address - Fax:787-675-9228
Practice Address - Street 1:EDIFICIO CENTERPLEX CARR#2 KM133.5
Practice Address - Street 2:SUITE 307
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-908-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16229207V00000X
PAMD072015L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH69121Medicare UPIN