Provider Demographics
NPI:1265815724
Name:BONILLA, JULIETA QUIA (RN)
Entity Type:Individual
Prefix:
First Name:JULIETA
Middle Name:QUIA
Last Name:BONILLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JULIETA
Other - Middle Name:QUIA
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:94-808 KIME ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1290
Mailing Address - Country:US
Mailing Address - Phone:808-351-4025
Mailing Address - Fax:
Practice Address - Street 1:94-808 KIME ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1290
Practice Address - Country:US
Practice Address - Phone:808-351-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-150018253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care