Provider Demographics
NPI:1194939561
Name:EMPRESAS BONILLA COLON
Entity type:Organization
Organization Name:EMPRESAS BONILLA COLON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LCDA
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-847-8600
Mailing Address - Street 1:CARR.149 KM 58.1 BO. TIERRA SANTA
Mailing Address - Street 2:P.O.BBOX 1542
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-1542
Mailing Address - Country:US
Mailing Address - Phone:787-847-8600
Mailing Address - Fax:787-847-3336
Practice Address - Street 1:CARR.149 KM 58.1 BO. TIERRA SANTA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-1542
Practice Address - Country:US
Practice Address - Phone:787-847-8600
Practice Address - Fax:787-847-3336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPRESAS BONILLA COLON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5559900001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4007870OtherNABP
PR4007870OtherNABP