Provider Demographics
NPI:1326803669
Name:HARRIS, VALERIA BONILLA
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:BONILLA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1707 ORLANDO CENTRAL PKWY STE 480
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5785
Mailing Address - Country:US
Mailing Address - Phone:407-382-9079
Mailing Address - Fax:
Practice Address - Street 1:1707 ORLANDO CENTRAL PKWY STE 480
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5785
Practice Address - Country:US
Practice Address - Phone:407-382-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation