Jesse Anthony Bonilla, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95028137 Issued in CA

Practice address

2112 E 4TH St Ste 228a
Santa Ana, CA 92705-3840

Phone

(714) 420-9890

Fax

(949) 749-7433

NPI assigned

Nov 29, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jab@mcsl-ca.direct.office.nextgen.com
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neurodivergent Psychiatric Specialists

  • Internal Medicine Physician
  • Santa Ana, CA
  • NPI 1417848219

  Psychiatric/Mental Health

  Medicare reassignment NPD Authorized official
• Hoag Hospital

  • General Acute Care Hospital
  • Newport Beach, CA
  • NPI 1689864365
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1689440711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 E 4TH ST STE 228",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053840",
            "telephone_number": "714-420-9890",
            "fax_number": "949-749-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 E 4TH ST STE 228A",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053840",
            "telephone_number": "714-420-9890",
            "fax_number": "949-749-7433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "JESSE",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-29",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95028137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CB540002",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Rose Bondar, MS
• Liane C. Bondoc
• Ashley Reiko Bone, CPNP
• Kelly Adeline Bonham
• Dezerae Divina Bonilla
• Juan Jesus Bonilla, MSW
• Sarah Michelle Bonner
• Kimberly Bono-Nguyen, LMFT
• Sharon Louise Bonutto-Smith, NP
• Bahareh Bonyadi, D.O.

• Psychiatric/Mental Health Nurse Practitioner in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.