Provider Demographics
NPI:1720304322
Name:BONILLA, ROSA (SOCIAL WORKER)
Entity Type:Individual
Prefix:MISS
First Name:ROSA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1791
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-1791
Mailing Address - Country:US
Mailing Address - Phone:787-317-8774
Mailing Address - Fax:
Practice Address - Street 1:CARRETERRA 152 KM 12 HM 4
Practice Address - Street 2:APARTADO 515
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0000
Practice Address - Country:US
Practice Address - Phone:787-869-5900
Practice Address - Fax:787-722-6980
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3448104100000X
PRPUERTO RICO #3448104100000X
PRITIN#3448104100000X
ITIN #3448104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker