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General NPI Number Information
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NPI Number | 1316477250
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Entity Type | Individual
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Provider Name | STEPHANIE BONILLA
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Gender | Female
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 590 W 8TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-3120
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Country | US
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Telephone | 310-831-2358
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Fax |
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Provider Business Mailing Address
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Address Line | 1318 N AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744-2639
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Country | US
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Telephone | 310-549-2710
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Fax | 310-549-2715
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 7561
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License Number State | CA
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