Provider Demographics
NPI:1588790463
Name:BONILLA REYES, GISEL MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:GISEL
Middle Name:MARIE
Last Name:BONILLA REYES
Suffix:
Gender:F
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:FARAYON 3333 URB ALTURAS DE MAYAGUEZ
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:787-672-1939
Mailing Address - Fax:
Practice Address - Street 1:CLINICA YAGUEZ CALLE ESTACION 117
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15608173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR130955Medicare UPIN
PR0023133Medicare ID - Type UnspecifiedMEDICARE