Provider Demographics
NPI:1326790098
Name:BONILLA, BRENDA L (LVN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:BONILLA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:2916 ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1707
Mailing Address - Country:US
Mailing Address - Phone:805-816-6521
Mailing Address - Fax:
Practice Address - Street 1:811 W TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-5400
Practice Address - Country:US
Practice Address - Phone:888-255-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA702635164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse