Provider Demographics
NPI:1679763619
Name:DUMONT BONILLA, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:DUMONT BONILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:DUMONT BONILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:APARTADO 409
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0409
Mailing Address - Country:US
Mailing Address - Phone:787-519-4360
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE MENDEZ CARDONA #3
Practice Address - Street 2:CALLE JOSE MENDEZ CARDONA #3
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0409
Practice Address - Country:US
Practice Address - Phone:787-896-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR03404183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR03404OtherLICENCIA TECNICA DE FARMA