Healthcare Provider Details

I. General information

NPI: 1952449068
Provider Name (Legal Business Name): CYNTHIA BONILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 CHERRY AVE STE 211
BREMERTON WA
98310-4208
US

IV. Provider business mailing address

2601 CHERRY AVE STE 211
BREMERTON WA
98310-4208
US

V. Phone/Fax

Practice location:
  • Phone: 564-333-4267
  • Fax: 360-218-7967
Mailing address:
  • Phone: 564-333-4267
  • Fax: 360-218-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1124195540
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60072475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: