Healthcare Provider Details

I. General information

NPI: 1578934485
Provider Name (Legal Business Name): MRS. JASHIRA URENA BONILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROBERTO CLEMENTE HSING EDIFICIO 30
CAROLINA PR
00987-7329
US

IV. Provider business mailing address

PO BOX 1356
JUNCOS PR
00777-1356
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax:
Mailing address:
  • Phone: 787-514-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number798
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: