Provider Demographics
NPI:1073039210
Name:BONILLA, LINNETTE (MS)
Entity Type:Individual
Prefix:
First Name:LINNETTE
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12485 SW 137TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4219
Mailing Address - Country:US
Mailing Address - Phone:305-846-9807
Mailing Address - Fax:305-846-9711
Practice Address - Street 1:6270 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33068-4902
Practice Address - Country:US
Practice Address - Phone:954-868-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst