Healthcare Provider Details

I. General information

NPI: 1720656358
Provider Name (Legal Business Name): REYNA CRISTINA BONILLA ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REYNA CRISTINA HERRERA

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 N VAN NESS AVE
FRESNO CA
93701-1671
US

IV. Provider business mailing address

2445 W WHITES BRIDGE AVE
FRESNO CA
93706-1225
US

V. Phone/Fax

Practice location:
  • Phone: 559-428-3052
  • Fax: 559-465-8052
Mailing address:
  • Phone: 559-264-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123796
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-FWDSJV
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number123796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: