MEDICARE: RICARDO E BONILLA CORTES

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	3416L0300X	Land Ambulance	TC AMB 383	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	991236	OTHER	PR	PMC
2	999517	OTHER	PR	MMM

General Provider Information

NPI Number	:	1881645935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICARDO E BONILLA CORTES

Provider Business Mailing Address
First Line	:	HC 1 BOX 17340
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603-9364
Country	:	US
Telephone Number	:	787-319-4609
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARRETERA 467 KM 1.6 INT
Second Line	:	BARRIO BORINQUEN
City	:	AGUADILLA
State	:	PR
Zip	:	00603-0000
Country	:	US
Telephone Number	:	787-319-4609
Fax Number	:	787-551-7104

Authorized Official
Title or Position	:	OWNER
Name	:	RICARDO E BONILLA CORTES
Credential	:
Telephone Number	:	787-319-4609

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	06/03/2013

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Directions to “RICARDO E BONILLA CORTES ” Practice Location

Language	Start Address	Practice Location

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