MEDICARE: CAMBIOS EN VIDA HEALTH MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1609727544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMBIOS EN VIDA HEALTH MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	1050 AVE LAS PALMAS # L-4
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-5220
Country	:	US
Telephone Number	:	939-588-0326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 AVE LAS PALMAS # L-4
Second Line	:	CONDOMINIO PUERTA DE LA BAHIA
City	:	SAN JUAN
State	:	PR
Zip	:	00907-5220
Country	:	US
Telephone Number	:	939-588-0326
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GABRIEL ENRIQUE BONILLA
Credential	:	MD
Telephone Number	:	787-204-8378

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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