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General NPI Number Information
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NPI Number | 1235764630
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Entity Type | Individual
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Provider Name | CONRAD BONILLA PMHNP
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Gender | Male
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 1775 CHESTNUT AVE
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City | LONG BEACH
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State | CA
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Zip | 90813-1674
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Country | US
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Telephone | 562-599-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 980 S LOS ROBLES AVE
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City | PASADENA
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State | CA
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Zip | 91106-4362
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Country | US
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Telephone | 323-606-3189
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95036333
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License Number State | CA
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