Provider Demographics
NPI:1801592241
Name:BONILLA, LIZ ARKADIA (MHS)
Entity type:Individual
Prefix:
First Name:LIZ
Middle Name:ARKADIA
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CALLE VALLE DEL TOA
Mailing Address - Street 2:URB VALLE DE ENSUENOS
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-202-1586
Mailing Address - Fax:
Practice Address - Street 1:BONNEVILLE HEIGHTS
Practice Address - Street 2:CALLE AIBONITO #60
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-395-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7502103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling