Healthcare Provider Details

I. General information

NPI: 1003448507
Provider Name (Legal Business Name): JENNIFER BONILLA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 11/13/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H23 AVE PINO
CAGUAS PR
00725-6146
US

IV. Provider business mailing address

VILLA BLANCA CALLE TURQUESA #63
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-344-1392
  • Fax:
Mailing address:
  • Phone: 787-344-1392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number851
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: