Provider Demographics
NPI:1245680479
Name:BONILLA, GABRIEL (M D)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:BONILLA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 CALLE SANTIAGO OPPENHEIMER
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-3900
Mailing Address - Country:US
Mailing Address - Phone:787-204-8378
Mailing Address - Fax:
Practice Address - Street 1:1542 CALLE SANTIAGO OPPENHEIMER
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-3900
Practice Address - Country:US
Practice Address - Phone:787-204-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR213862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry