Individual provider · NPI-1

Andra Joann Bonilla

Day Training/Habilitation Specialist · Gardena, CA

NPI number1205020328
StatusActive
Last updated in NPPESMay 19, 2025

Details

NPI
1205020328
Entity type
Individual (NPI-1)
Name
Mrs. Andra Joann Bonilla
Sex
Female
Sole proprietor
No
Enumeration date
Aug 31, 2007
Certification date
May 19, 2025
Last updated
May 19, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
373H00000X Day Training/Habilitation Specialist––Yes
101YA0400X Counselor, Addiction (Substance Use Disorder)––
172V00000X Community Health Worker––

Practice location

108 W Victoria St
Gardena, CA 90248-3523

Phone 310-715-2020

Mailing address

108 W Victoria St
Gardena, CA 90248-3523

Phone 310-715-2020

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