Provider Demographics
NPI:1134156375
Name:AVILES BONILLA, DIANA M (MA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:AVILES BONILLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:AVILES BONILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CALLE 13 E-45 URB.VILLA NUEVA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-245-6861
Mailing Address - Fax:
Practice Address - Street 1:CALLE 13 E-45 URB.VILLA NUEVA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-245-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist