Provider Demographics
NPI:1902505464
Name:BONILLA, JASMIN EMELI (NP)
Entity Type:Individual
Prefix:MS
First Name:JASMIN
Middle Name:EMELI
Last Name:BONILLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1557 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-2597
Mailing Address - Country:US
Mailing Address - Phone:323-584-1490
Mailing Address - Fax:323-584-1489
Practice Address - Street 1:1557 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-2597
Practice Address - Country:US
Practice Address - Phone:323-584-1490
Practice Address - Fax:323-584-1489
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95024300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95024300OtherCALIFORNIA BOARD OF NURSING NP LICENSE