| Doctor Name: | GLADYMAR BONILLA DIAZ |
| NPI Number: | 1134575111 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D |
| License Number: | 004651 |
| Business Practice Address: | A-13 Calle 1 Urb Rio Grande Estate Rio Grande, PR - 00745 |
| Business Phone Number: | 7876470729 |
| Business Fax Number: | |
| Mailing Address: | A-13 Calle 1, Urb Rio Grande Estate RIO GRANDE |
| State: | PR |
| Postal Code: | 00745 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/10/2016 |
| NPI Last Update Date: | 05/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | 004651 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |