Provider Demographics
NPI:1700345915
Name:BONNER, ALEJANDRA MARIA
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:MARIA
Last Name:BONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:MARIA
Other - Last Name:TESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 S PINE ISLAND RD APT 316
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2651
Mailing Address - Country:US
Mailing Address - Phone:954-604-3014
Mailing Address - Fax:
Practice Address - Street 1:14201 W SUNRISE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:954-851-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician