Provider Demographics
NPI:1205987294
Name:BONILLA VELEZ, ONIX (MD)
Entity type:Individual
Prefix:DR
First Name:ONIX
Middle Name:
Last Name:BONILLA VELEZ
Suffix:
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:PMB 431
Mailing Address - Street 2:P.O.BOX 5075
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-892-2626
Mailing Address - Fax:787-892-2626
Practice Address - Street 1:AVE.UNIVERSIDAD INTERAMERICANA
Practice Address - Street 2:#18
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-2626
Practice Address - Fax:787-892-2626
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22108Medicare ID - Type Unspecified