Healthcare Provider Details

I. General information

NPI: 1609727544
Provider Name (Legal Business Name): CAMBIOS EN VIDA HEALTH MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 AVE LAS PALMAS # L-4 CONDOMINIO PUERTA DE LA BAHIA
SAN JUAN PR
00907-5220
US

IV. Provider business mailing address

1050 AVE LAS PALMAS # L-4
SAN JUAN PR
00907-5220
US

V. Phone/Fax

Practice location:
  • Phone: 939-588-0326
  • Fax:
Mailing address:
  • Phone: 939-588-0326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL ENRIQUE BONILLA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-204-8378