Provider Demographics
NPI:1508405226
Name:BONILLA, GLENDA
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
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 1:1 HEMLOCK TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-6198
Mailing Address - Country:US
Mailing Address - Phone:352-355-5143
Mailing Address - Fax:
Practice Address - Street 1:1 HEMLOCK TERRACE CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-6198
Practice Address - Country:US
Practice Address - Phone:352-355-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2024-02-15
Deactivation Date:2024-02-05
Deactivation Code:
Reactivation Date:2024-02-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist