Provider Demographics
NPI:1770375255
Name:BONILLA MORALES, ILENIA (BA)
Entity type:Individual
Prefix:
First Name:ILENIA
Middle Name:
Last Name:BONILLA MORALES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. PASEOS REALES #313 CALLE ALARCON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690
Mailing Address - Country:US
Mailing Address - Phone:787-629-8469
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1561
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-1561
Practice Address - Country:US
Practice Address - Phone:787-818-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant