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General NPI Number Information
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NPI Number | 1588790463
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Entity Type | Individual
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Provider Name | GISEL MARIE BONILLA REYES MD
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CLINICA YAGUEZ CALLE ESTACION 117
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City | MAYAGUEZ
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State | PR
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Zip | 00680
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Country | US
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Telephone | 787-832-0444
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Fax |
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Provider Business Mailing Address
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Address Line | FARAYON 3333 URB ALTURAS DE MAYAGUEZ
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City | MAYAGUEZ
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State | PR
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Zip | 00682
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Country | US
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Telephone | 787-672-1939
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 15608
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License Number State | PR
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