MEDICARE: AILEEN 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	106S00000X	Behavior Technician	RBT-25-409831	FL

General Provider Information

NPI Number	:	1609662717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN BONILLA

Provider Business Mailing Address
First Line	:	14701 NE 5TH CT
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-2122
Country	:	US
Telephone Number	:	786-587-5512
Fax Number	:

Provider Business Practice Location Address
First Line	:	14701 NE 5TH CT
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-2122
Country	:	US
Telephone Number	:	786-587-5512
Fax Number	:

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

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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Directions to “ AILEEN BONILLA ” Practice Location

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