Active NPI
Jessica Bonilla
- Registered Dietitian
- San Diego, CA
National Provider Identifier
1912668989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 650 Dennery Rd Unit 531774
San Diego, CA 92153-2971 - Phone
- (619) 636-7322
- NPI assigned
- Jan 3, 2022
- Last updated
- Aug 29, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | NU | Primary |
Addresses
Primary practice location
650 Dennery Rd Unit 531774
San Diego, CA 92153-2971
Mailing address
PO Box 531774
San Diego, CA 92153-1774
Phone (619) 636-7322
Other practice location 1
5220 Sunnyside Dr
Bonita, CA 91902-2133
Phone (619) 636-7322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
19 W 24TH St
FL 4
New York, NY 10010-3239
19 W 24TH St FL
Suite 4
New York, NY 10010-3239
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BSH Health PA | Dietitian, Registered | Current | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Locations
19 W 24th St
Fl 4
New York, NY 10010
Phone (646) 844-2332
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724889600000",
"number": "1912668989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 531774",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921531774",
"telephone_number": "619-636-7322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 DENNERY RD UNIT 531774",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921532971",
"telephone_number": "619-636-7322"
}
],
"practiceLocations": [
{
"address_1": "5220 Sunnyside Dr",
"address_purpose": "LOCATION",
"city": "Bonita",
"state": "CA",
"postal_code": "919022133",
"country_code": "US",
"telephone_number": "619-636-7322",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BONILLA",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-03",
"last_updated": "2024-08-29",
"certification_date": "2024-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.