# JORGE L BONILLA MD PSC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JORGE L BONILLA MENDEZ
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568700664
- **Authorized official:** DR. JORGE BONILLA M.D (PRESIDENT)
- **Authorized official phone:** (787) 464-4559

## Contact information

- **Practice address:** 167 CALLE RAMOS ANTONINI E, MAYAGUEZ, PR 00680-5039
- **Practice address phone:** (787) 464-4559
- **Mailing address:** PO BOX 4223, MAYAGUEZ, PR 00681-4223
- **Mailing address phone:** (787) 464-4559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 18209 | PR | Yes |

## Other

- **Enumeration date:** 01/24/2013
- **Last updated:** 01/24/2013