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General NPI Number Information
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NPI Number | 1609727544
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Entity Type | Organization
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Legal Business Name | CAMBIOS EN VIDA HEALTH MANAGEMENT LLC
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 1050 AVE LAS PALMAS # L-4 CONDOMINIO PUERTA DE LA BAHIA
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City | SAN JUAN
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State | PR
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Zip | 00907-5220
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Country | US
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Telephone | 939-588-0326
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 AVE LAS PALMAS # L-4
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City | SAN JUAN
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State | PR
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Zip | 00907-5220
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Country | US
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Telephone | 939-588-0326
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GABRIEL ENRIQUE BONILLA
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Credential | MD
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Telephone | 787-204-8378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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