Healthcare Provider Details

I. General information

NPI: 1669019618
Provider Name (Legal Business Name): ALEJANDRA BONILLA-ROJAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 W LEGION RD STE 102
BRAWLEY CA
92227-7754
US

IV. Provider business mailing address

516 W ATEN RD STE 2
IMPERIAL CA
92251-9805
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-8696
  • Fax: 760-545-0253
Mailing address:
  • Phone: 760-355-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: