Healthcare Provider Details

I. General information

NPI: 1265815724
Provider Name (Legal Business Name): JULIETA QUIA BONILLA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIETA QUIA BONILLA RN

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 61ST LOOP SE
LACEY WA
98513-4103
US

IV. Provider business mailing address

6307 61ST LOOP SE
LACEY WA
98513-4103
US

V. Phone/Fax

Practice location:
  • Phone: 808-351-4025
  • Fax: 360-878-9224
Mailing address:
  • Phone: 808-351-4025
  • Fax: 360-878-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number756362
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: