Provider Demographics
NPI:1942316237
Name:BONILLA TIRADO, VANESSA IVONNE (OTL)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:IVONNE
Last Name:BONILLA TIRADO
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40260
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00940-0260
Mailing Address - Country:US
Mailing Address - Phone:787-479-3998
Mailing Address - Fax:
Practice Address - Street 1:VILLA CAROLINA CALLE 435 BLOQUE 192 #18
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-750-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist