Provider Demographics
NPI:1740427194
Name:BONILLA, RICARDO E SR
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:E
Last Name:BONILLA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSHUAS
Other - Middle Name:PARAMEDIC
Other - Last Name:RESCUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:BORINQUEN PLZ # 467
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5970
Mailing Address - Country:US
Mailing Address - Phone:797-319-4604
Mailing Address - Fax:787-882-2289
Practice Address - Street 1:CARRETERA 467
Practice Address - Street 2:BARRIO BORINQUEN
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-319-4604
Practice Address - Fax:787-882-2289
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB3833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057694Medicare PIN