Provider Demographics
NPI:1447927710
Name:MEDINA BONILLA, DUBIEZEL (MD)
Entity type:Individual
Prefix:DR
First Name:DUBIEZEL
Middle Name:
Last Name:MEDINA BONILLA
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:HC 1 BOX 6664
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-9714
Mailing Address - Country:US
Mailing Address - Phone:787-237-1235
Mailing Address - Fax:
Practice Address - Street 1:CARR 345 INT KM 3.3 SECTOR COLOSO MEDINA BO LAVADERO
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-9714
Practice Address - Country:US
Practice Address - Phone:787-237-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15458I390200000X
PR22470208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program