Provider Demographics
NPI:1871697045
Name:BONILLA, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BONILLA
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 1:442 AVE JUAN ROSADO STE 4
Mailing Address - Street 2:ARECIBO COMMUNITY BASED OUTPATIENT CLINIC
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4241
Mailing Address - Country:US
Mailing Address - Phone:787-641-7582
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL METROPOLITANO DE ARECIBO
Practice Address - Street 2:ZONA INDUSTRIAL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-1818
Practice Address - Fax:787-816-1824
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PROTHOOMedicare UPIN