Provider Demographics
NPI:1821390337
Name:BONILLA, MIOSOTIS
Entity Type:Individual
Prefix:MRS
First Name:MIOSOTIS
Middle Name:
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 1:8145 CALLE SUR
Mailing Address - Street 2:URB. LOS MAESTROS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8145 CALLE SUR
Practice Address - Street 2:URB. LOS MAESTROS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0262
Practice Address - Country:US
Practice Address - Phone:787-317-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical