Provider Demographics
NPI:1275921504
Name:BONILLA, ADA N (RN)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:N
Last Name:BONILLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIPOLITO ARROYO A 29 PARCELAS CASTILLO
Mailing Address - Street 2:PARCELAS CASTILLO
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1308
Mailing Address - Country:US
Mailing Address - Phone:787-673-0261
Mailing Address - Fax:
Practice Address - Street 1:A29 CALLE HIPOLITO ARROYO
Practice Address - Street 2:PARCELAS CASTILLO
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1308
Practice Address - Country:US
Practice Address - Phone:178-767-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18029163W00000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care