Provider Demographics
NPI:1174900393
Name:BONILLA, CARLOS ALEJANDRO SR
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALEJANDRO
Last Name:BONILLA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1508
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1508
Mailing Address - Country:US
Mailing Address - Phone:787-975-6277
Mailing Address - Fax:
Practice Address - Street 1:CARR 171 KM 3.9
Practice Address - Street 2:BO RINCON
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-975-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR118491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical