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General NPI Number Information
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NPI Number | 1477210466
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Entity Type | Individual
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Provider Name | ANNEMARIE MIRANDA BONILLA PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 11460 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-6030
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Country | US
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Telephone | 310-337-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 16055 RAYEN ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-4848
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Country | US
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Telephone | 415-328-0915
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 301279
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License Number State | CA
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