Provider Demographics
NPI:1336979707
Name:BONILLA SOTO, PABLO CARLOS ((MD))
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:CARLOS
Last Name:BONILLA SOTO
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 58 BOX 13745
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9899
Mailing Address - Country:US
Mailing Address - Phone:787-689-1075
Mailing Address - Fax:
Practice Address - Street 1:HC 58 BOX 13745
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9899
Practice Address - Country:US
Practice Address - Phone:787-689-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR024640208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice