Provider Demographics
NPI:1245970748
Name:BONILLA, JOHANCARINA
Entity type:Individual
Prefix:
First Name:JOHANCARINA
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 NELSON AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-2446
Mailing Address - Country:US
Mailing Address - Phone:347-863-2383
Mailing Address - Fax:
Practice Address - Street 1:1360 NELSON AVE APT 4D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2446
Practice Address - Country:US
Practice Address - Phone:347-863-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker