Healthcare Provider Details

I. General information

NPI: 1407188915
Provider Name (Legal Business Name): MARIA CRISTINA BONILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W GONZALES RD
OXNARD CA
93036-3336
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-751-4765
  • Fax: 805-973-8871
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT16368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: