Provider Demographics
NPI:1184939498
Name:BONILLA, AMANCIA (TR)
Entity type:Individual
Prefix:MRS
First Name:AMANCIA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:TR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 72
Mailing Address - Street 2:BLOQUE 125 CASA 16
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:778-763-7575
Mailing Address - Fax:
Practice Address - Street 1:CALLE 72
Practice Address - Street 2:BLOQUE 125 CASA 16
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-9711
Practice Address - Country:US
Practice Address - Phone:778-763-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist