MEDICARE: KAYLA BONILLA

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	:	1235945734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA BONILLA

Provider Business Mailing Address
First Line	:	117 N R ST
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-4465
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 N R ST
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-4465
Country	:	US
Telephone Number	:	559-395-0450
Fax Number	:

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

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	04/06/2026

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Directions to “ KAYLA BONILLA ” Practice Location

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