# BONILLA GASTROENTEROLOGY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689389223
- **Authorized official:** FERNANDO BONILLA VALENTIN MD (PRESIDENTE)
- **Authorized official phone:** (787) 215-6410

## Contact information

- **Practice address:** 187 AVE UNIVERSIDAD INTERAMERICANA, EDIFICIO RALI, SAN GERMAN, PR 00683-0068
- **Practice address phone:** (787) 215-6410
- **Mailing address:** PO BOX 1387, CABO ROJO, PR 00623-1387
- **Mailing address phone:** (787) 215-6410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/18/2023
- **Last updated:** 01/18/2023