Provider Demographics
NPI:1669293759
Name:BONILLA-ORTIZ, ELIENID
Entity type:Individual
Prefix:
First Name:ELIENID
Middle Name:
Last Name:BONILLA-ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOS CHOFERES CALLE JUAN D.LEFEBRE
Mailing Address - Street 2:APARTMENT B18-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-685-4413
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND PASEO BOUVELARD
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-685-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program