Healthcare Provider Details

I. General information

NPI: 1932603347
Provider Name (Legal Business Name): BERENISE BONILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37141 2ND ST
FREMONT CA
94536-2835
US

IV. Provider business mailing address

37141 2ND ST
FREMONT CA
94536-2835
US

V. Phone/Fax

Practice location:
  • Phone: 510-793-1141
  • Fax:
Mailing address:
  • Phone: 510-793-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number260113404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: