Provider Demographics
NPI:1437603248
Name:BONILLA, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-216 LOKU PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5505
Mailing Address - Country:US
Mailing Address - Phone:808-888-8577
Mailing Address - Fax:808-888-8577
Practice Address - Street 1:94-216 LOKU PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5505
Practice Address - Country:US
Practice Address - Phone:808-888-8577
Practice Address - Fax:808-888-8577
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI020401540376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide