Wally Lopez Bonilla, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

11784 Issued in PR

Practice address

Hospital la Concepcion Carr # 2 KM.173.4 2ND Floor
San German, PR 00683

Phone

(787) 892-6972

NPI assigned

Dec 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Anesthesia Associates LLC

  • Specialist
  • Ponce, PR
  • NPI 1336120153
  Medicare reassignment NPD
• Hospital Damas Inc

  • General Acute Care Hospital
  • Ponce, PR
  • NPI 1730159286
  NPD
• SG Blood Saver, Inc

  • Blood Bank
  • San German, PR
  • NPI 1356619928
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264118400000",
    "number": "1780748236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HOSPITAL LA CONCEPCION CARR # 2 KM.173.4 2ND FLOOR",
            "city": "SAN GERMAN",
            "state": "PR",
            "postal_code": "00683",
            "telephone_number": "787-892-6972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HOSPITAL LA CONCEPCION CARR # 2 KM.173.4 2ND FLOOR",
            "city": "SAN GERMAN",
            "state": "PR",
            "postal_code": "00683",
            "telephone_number": "787-892-6972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ BONILLA",
        "first_name": "WALLY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2010-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PR",
            "license": "11784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harvey Lebron, M.D.
• Ernesto Licort Garcia, MEDICO
• Light Up Chiropractic Clinic
• Sylvia G. Llantin, PHARMACIST
• Asbelti Llorens, M.D.
• Melissa Lopez Hernandez, MD
• Valeria Lopez Lozano, MD
• Jean Francis Lopez Ruiz, MD
• Angel J. Lopez-Garib, MD
• Fanny Rubi Lopez, M.D.

• Anesthesiology Physician in San German, PR
• Providers in San German, PR by specialty
• Anesthesiology Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.