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General NPI Number Information
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NPI Number | 1649107574
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Entity Type | Individual
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Provider Name | JASON BONILLA
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Gender | Male
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 39 HUNTER POINT RD
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City | POMONA
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State | CA
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Zip | 91766-4959
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Country | US
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Telephone | 909-670-6416
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Fax |
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Provider Business Mailing Address
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Address Line | 39 HUNTER POINT RD
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City | POMONA
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State | CA
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Zip | 91766-4959
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Country | US
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Telephone | 909-670-6416
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 21249
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License Number State | CA
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