MEDICARE: VINCENT JOHNNY BONILLA JR.

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	373H00000X	Day Training/Habilitation Specialist		CA

General Provider Information

NPI Number	:	1164370912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT JOHNNY BONILLA JR.

Provider Business Mailing Address
First Line	:	510 S VERMONT AVE FL 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1912
Country	:	US
Telephone Number	:	213-948-2980
Fax Number	:	213-652-1857

Provider Business Practice Location Address
First Line	:	510 S VERMONT AVE FL 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1912
Country	:	US
Telephone Number	:	213-948-2980
Fax Number	:	213-652-1857

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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