Provider Demographics
NPI:1376899435
Name:BONILLA, JULIANA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD. NW
Mailing Address - Street 2:MARCUS BLES BLDG; RM CG-12
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-444-4180
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW BLDG RM
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019005712174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist