Basic Information
| Provider Information | |||||||||
| NPI: | 1588220842 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICIO BONILLA L.L.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOSPICIO BONILLA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 CALLE BASILIO CATALA | ||||||||
| Address2: | COND PRADOS DEL MONTE APT 709 | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874245533 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | HOSPITAL HIMA-SAN PABLO CAGUAS | ||||||||
| Address2: | FACULTAD MEDICA HIMA SP-CAGUAS APARTADO 4980 | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | 7879614562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2019 | ||||||||
| LastUpdateDate: | 05/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | BONILLA | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7874245533 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 315D00000X | N | Nursing & Custodial Care Facilities | Hospice, Inpatient | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.