Healthcare Provider Details

I. General information

NPI: 1801592241
Provider Name (Legal Business Name): LIZ ARKADIA BONILLA LEON MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 198 KILOMETRO 10.1 BARRIO MABU SECTOR LA FERMINA
HUMACAO PR
00791-4220
US

IV. Provider business mailing address

12 CALLE COSTA
JUNCOS PR
00777-3236
US

V. Phone/Fax

Practice location:
  • Phone: 787-462-6447
  • Fax:
Mailing address:
  • Phone: 787-462-6447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7502
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: