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NPI Code Detail

MEDICARE: WENDY BONILLA

MEDICARE: WENDY 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1396217550
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY BONILLA
Provider Business Mailing Address
First Line : 8200 PROFESSIONAL PL STE 115
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-2293
Country : US
Telephone Number : 443-330-7900
Fax Number :
Provider Business Practice Location Address
First Line : 8200 PROFESSIONAL PL STE 115
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-2293
Country : US
Telephone Number : 443-330-7900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2018
Last Update Date : 12/27/2018

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Directions to “ WENDY BONILLA ” Practice Location

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