MEDICARE: LINDA BONILLA MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 41224	CA

General Provider Information

NPI Number	:	1023321221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA BONILLA MFT

Provider Business Mailing Address
First Line	:	PO BOX 92622
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91109-2622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 HONOLULU AVE
Second Line	:	SUITE 107
City	:	MONTROSE
State	:	CA
Zip	:	91020-1858
Country	:	US
Telephone Number	:	626-430-0500
Fax Number	:	818-249-8858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	12/23/2010

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Directions to “ LINDA BONILLA MFT” Practice Location

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