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General NPI Number Information
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NPI Number | 1689544645
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Entity Type | Individual
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Provider Name | ALEJANDRO LUIS BONILLA
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Gender | Male
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 881 NEW HARWINTON RD
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City | TORRINGTON
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State | CT
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Zip | 06790-5948
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Country | US
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Telephone | 203-441-4261
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Fax | 860-736-5013
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Provider Business Mailing Address
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Address Line | 176 LANING ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-1603
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Country | US
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Telephone | 203-441-4261
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Fax | 860-736-5013
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 15178
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License Number State | CT
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