Provider Demographics
NPI:1144286055
Name:BONILLA-FELIX, MELVIN A (M D)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:A
Last Name:BONILLA-FELIX
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POPPY B-4
Mailing Address - Street 2:PARQUE FORESTAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-726-1113
Mailing Address - Fax:
Practice Address - Street 1:252 CALLE CONVENTO
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3207
Practice Address - Country:US
Practice Address - Phone:787-726-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR94772080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF31791Medicare UPIN