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General NPI Number Information
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NPI Number | 1457218422
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Entity Type | Individual
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Provider Name | MR. PEDRO WILLIAM BONILLA MARTIR SR.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | CARR # 120 KM. 32.7 INT SECTOR LA JUANITA
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City | LAS MARIAS, PR
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State | PR
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Zip | 00670
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Country | US
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Telephone | 787-295-6450
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Fax |
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Provider Business Mailing Address
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Address Line | HC 1 BOX 5951
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City | LAS MARIAS
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State | PR
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Zip | 00670-9736
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Country | US
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Telephone | 787-295-6450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 4330-E
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License Number State | PR
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