Healthcare Provider Details

I. General information

NPI: 1093341604
Provider Name (Legal Business Name): JENNIFER CINDY BONILLA-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 06/04/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 BUSINESS CENTER DR
SAN BERNARDINO CA
92408-3436
US

IV. Provider business mailing address

26585 PACIFIC ST
HIGHLAND CA
92346-2416
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-5930
  • Fax:
Mailing address:
  • Phone: 909-936-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: