Provider Demographics
NPI:1356196604
Name:BONILLA, MARIA S
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:S
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 1:3460 BAILEY AVE APT 1R
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4264
Mailing Address - Country:US
Mailing Address - Phone:323-403-8611
Mailing Address - Fax:
Practice Address - Street 1:3460 BAILEY AVE APT 1R
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4264
Practice Address - Country:US
Practice Address - Phone:323-403-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL62546374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula