Healthcare Provider Details

I. General information

NPI: 1194652958
Provider Name (Legal Business Name): PACIFICO SANITAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 TREMONT ST
BOSTON MA
02111-1208
US

IV. Provider business mailing address

757 GALLIVAN BLVD STE 1
DORCHESTER MA
02122-3190
US

V. Phone/Fax

Practice location:
  • Phone: 617-819-1227
  • Fax:
Mailing address:
  • Phone: 617-819-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GISELLE BONILLA
Title or Position: PROVIDER
Credential:
Phone: 617-819-1227