Healthcare Provider Details

I. General information

NPI: 1306772785
Provider Name (Legal Business Name): KENIA BONILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7247 DAZZLE POINT ST
NORTH LAS VEGAS NV
89084-4745
US

IV. Provider business mailing address

7247 DAZZLE POINT ST
NORTH LAS VEGAS NV
89084-4745
US

V. Phone/Fax

Practice location:
  • Phone: 323-309-2088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number899851
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: