Provider Demographics
NPI:1578569869
Name:REGIS-BONILLA, FERNANDO LUIS JR (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:REGIS-BONILLA
Suffix:JR
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:PO BOX 3878
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3878
Mailing Address - Country:US
Mailing Address - Phone:787-997-1655
Mailing Address - Fax:787-997-1655
Practice Address - Street 1:SEVERIANO CUEVAS STREET KM.141.1
Practice Address - Street 2:BUEN SAMARITANO HOSPITAL
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-0003
Practice Address - Fax:787-997-1655
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6091207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77434Medicare UPIN
PR26568Medicare ID - Type Unspecified