Provider Demographics
NPI:1841625779
Name:BONILLA, JUAN JESUS (MSW)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:JESUS
Last Name:BONILLA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13962 GARDENIA CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0000
Mailing Address - Country:US
Mailing Address - Phone:714-328-6266
Mailing Address - Fax:
Practice Address - Street 1:405 W. 5TH ST
Practice Address - Street 2:590
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-0000
Practice Address - Country:US
Practice Address - Phone:714-834-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW355631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical