Healthcare Provider Details

I. General information

NPI: 1720971278
Provider Name (Legal Business Name): YADIRA BONILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PACIFIC ST
MONTEREY CA
93940-2864
US

IV. Provider business mailing address

3007 KING CIR
MARINA CA
93933-3616
US

V. Phone/Fax

Practice location:
  • Phone: 831-645-1261
  • Fax:
Mailing address:
  • Phone: 831-521-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number8AA6F3E932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: