Organization
JORGE L BONILLA MD PSC
Active
Other names
JORGE L BONILLA MENDEZ
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORGE BONILLA M.D (PRESIDENT)
(787) 464-4559
Entity
Organization
Contact information
Practice address
167 CALLE RAMOS ANTONINI E, MAYAGUEZ, PR 00680-5039
(787) 464-4559
Mailing address
PO BOX 4223, MAYAGUEZ, PR 00681-4223
(787) 464-4559
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18209
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18209
MEDICAL LICENCE
PR
Enumeration date
01/24/2013
Last updated
01/24/2013
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