Provider Demographics
NPI:1467159343
Name:BONILLA, SHARON (CTRS 82551)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:CTRS 82551
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CTRS
Mailing Address - Street 1:22012 BELSHIRE AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1675
Mailing Address - Country:US
Mailing Address - Phone:909-552-3080
Mailing Address - Fax:
Practice Address - Street 1:22012 BELSHIRE AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1675
Practice Address - Country:US
Practice Address - Phone:909-552-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82551225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist